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UnitedHealth Group Sr Clinical Pharmacist - Telecommute in California

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

  • Research and develop therapeutic clinical reviews and financial models for P&T, Medical Technology Assessment Committee (MTAC), or Specialist Advisory Boards or Committees

  • Synthesize detailed clinical evidence, safety profiles, quality of life, and real-world data related to specialty drugs/biologics & medical conditions to identify opportunities, establish care pathways/clinical algorithms, and integrate with POC systems, e.g. EHRs, Clinical Decision Support platforms

  • Analyze capitation and FFS spend and trends data (including E&M, drugs, EDs, hospitalizations, etc.) and identify mitigating strategies to lower trends while improving patient outcomes and healthcare value

  • Develop, implement, and support pharmacy & medical strategies and programs to achieve key strategic and business goals

  • Develop therapeutic pipeline monitoring and evaluation assets and tools

  • Manage clinical program implementations, including regulatory/statutory requirements in accordance with state, federal, CMS mandates and contractual agreements

  • Review programs for compliance to state, federal and CMS regulations and recommend remediation.

  • Monitor impending legislation for potential impact to current and future programs.

  • Analyze data and prepare management summaries related to work stream results, performance mgmt. results, audit results, CMS reporting, and client reporting.

  • Perform quality audits, determine program performance gaps and root causes, prepares reports and collaborates on remediation

  • Ensure alignment and understanding of program/project scope and objectives with the organization's strategic objectives and the Voice of the Customer(s)

  • Partners with executive leaders in the development of organizational objectives and short- and long- term goals, to identify/define performance planning/measures, programs, initiatives, based on emerging industry trends and growth opportunities

  • Collaborate with functionally diverse teams (MD, RN, PharmD, LCSW, PM, etc.) in order to achieve desired end-results and find innovative solutions for complex problems

  • Lead and guide functional and segment teams through project implementations with competing agendas and priorities

  • Creates compelling interactive dashboards for internal and external customers to identify, design, recommend and execute solutions to deliver actionable information

  • Develops appealing data visualizations leveraging multiple internal and external data sources (quantitative and qualitative), and drawing insightful conclusions for decisions makers

  • Solves unique and complex problems with broad impact on the business

  • Provides subject matter expertise and operational support to internal business partners

  • Coaches, mentors and provides feedback to others

  • Maintains project and process knowledge bank to support best practice identification and implementation

  • Collaborates cross departmentally to manage risk forecasting/mitigation, project progress and issue resolution efforts

  • Acts as a liaison between internal and external teams to help steer work stream communications to ensure response integrity

  • Influences senior leadership to adopt new ideas, products, and/or approaches that may have segment-wide impact

  • Performs all other related duties as assigned

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

  • Doctorate of Pharmacy (PharmD)

  • 5+ years clinical care, specialty pharmacy, health plan or PBM operations, including Medicare FFS, MAPD, Part B and D experience

  • 5+ years research upcoming drug releases and treatment guidelines/pathways, develop and maintain pharmacy programs, such as medical coverage specialty pharmacy, drug utilization review, prior authorization, health outcomes, disease state management, care management, and other specialty programs

  • 3+ Pharmacy & Therapeutics (P&T) or Medical Assessment Committee (MTAC) experience, with proven track record of translating research findings into actionable information to support business decisions and strategic development

  • 3+ years in a PBM or managed care plan, with understanding of provider network contracts and/or pharmaceutical rebates, must have a working knowledge of payer contracts, fee schedules, allowable tables, and understanding of government and commercial contracts and pricing

  • 3+ years professional project management experience

  • If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or similar UnitedHealth Group-approved symptom screener. When in a UnitedHealth Group building, employees are required to wear a mask in common areas. In addition, employees must comply with any state and local masking orders

Preferred Qualifications:

  • Oncology Board Certification (BCOP) or other

  • Advanced analytical and technical skills, including Tableau, Cognos, Business Objects, etc.

  • Strong Visio, SharePoint, Visio, MS Office Suite (including excel and access)

  • Advanced analytical and technical skills, including Tableau, SQL or SAS

  • Extensive knowledge of eligibility, claims (institutional, professional, labs, PBM/pharmacy), premiums, capitation, ETG, etc.

  • Strong prioritization, attention to detail, effective multi-tasking, verbal/written communication and organizational skills.

  • Ability to create an effective team environment, build strong relationships.

  • Strong in solving problems and issues in a matrix environment and communicating effectively at all levels of an organization.

  • Understanding of utilization management (UM) and prior authorization (PA) in the Medicare/Medicaid and Commercial LOBs as it relates to pharmacy and medical benefit

  • Demonstrated leadership & communication skills in developing content and presenting to various specialist subcommittees to drive consensus recommendations and clinical decisions

OptumCare is committed to creating an environment where physicians focus on what they do best: care for their patients. To do so, OptumCare provides administrative and business support services to both owned and affiliated medical practices which are part of OptumCare. Each medical practice part and their physician employees have complete authority with regards to all medical decision-making and patient care. OptumCare’s support services do not interfere with or control the practice of medicine by the medical practices or any of their physicians.

*All Telecommuters will be requierd to adhere to UnitedHealth Group's Telecommuter Policy

Colorado Residents Only: The salary for Colorado residents is $94,500 to $171,700 (add additional reference for sales and physicians). Pay is based on several factors including but not limited to education, work experience, certifications, etc. As of the date of this posting, In addition to your salary, UHG offers the following benefits for this position, subject to applicable eligibility requirements: Health, dental, and vision plans; wellness program; flexible spending accounts; paid parking or public transportation costs; 401(k) retirement plan; employee stock purchase plan; life insurance, short-term disability insurance, and long-term disability insurance; business travel accident insurance; Employee Assistance Program; PTO; and employee-paid critical illness and accident insurance.

Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment

Job keywords: Telecommute, work from home, WFH, travel, remote, Pharmacist, Clinical Pharmacist, Sr Clinical Pharmacist,Utilization Management, Part B, Oncology, Clinical Performance, Optum, UnitedHealth Group, UHG