The Clinical Pharmacist will be responsible for driving the overall market CMS STAR/HEDIS Pharmacy Measure Performance and Strategy. This individual will work directly with the Clinical Quality Management team, Market Medical Directors, and Client Services team to coach and guide the Midwest RBE to higher overall Quality Pharmacy Measure performance. The Clinical Pharmacist will also oversee the Market Pharmacy Technician team, ensuring effective membership outreach programs and handling pharmacist escalations. Additionally, they will develop and implement strategies to improve patient care, outcomes, and quality improvement metrics related to CMS HEDIS/Star ratings. This position will report directly to the Regional Quality Director.
You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:- Develop team direction and outreach/educational strategies around Quality Pharmacy STARs performance
- Stay knowledgeable of current and emerging clinical trends
- Actively participate in various clinical departmental meetings and forums to improve clinical programs, enhance processes, and share clinical information
- Continuously look for ways to streamline and improve workflow
- Adapt departmental plans and priorities to address business and operational challenges
- Collect Quality data and/or information based on applicable standards, state/federal or other regulations, customer or consumer requests, internal requests, or project assignments
- Serve as a clinical resource and consultant in all areas of pharmacy and medication management
- Develop effective methods for data/information collection
- Support medical management and pharmacy quality initiatives
- Investigate quality problems identified and collect additional information to close gaps
- Follow all policies and procedures related to the job
- Actively participate in process improvement planning and implementation while fostering good communication and collaboration across all affected departments
- Work cross-functionally and coordinate with others internally or externally to gather information and overcome challenges to obtaining needed information
- Mine data and/or information (e.g., clinical, administrative, Quality) to ensure they meet standards, are compliant, and/or are accurate and complete
- Serve as a subject matter expert (SME) for process/workflow-related questions
- Assist with gathering, analyzing, and interpreting data and metrics to evaluate the effectiveness of Optum Care Midwest Pharmacy programs/initiatives
- Identify Quality improvement or intervention opportunities and work cross-functionally to develop interventions and recommendations
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:- Pharmacist license without restrictions
- 4+ years of healthcare experience, including experience in a managed care setting
- 2+ years of managerial experience
- 2+ years of experience in HEDIS/Star programs, preferably in a clinical quality consultant role
- 2+ years of experience in provider facing interactions, including provider education
- 2+ years of experience with data analysis and/or quality chart reviews
- Experienced using Microsoft office applications, including databases, word-processing, and excel spreadsheets. Must be proficient in Excel
- Medicare experience
- Proven ability to review data and provide recommendations for improvement
- Ability to travel up to 25% with occasional overnight travel
*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $91,700 to $163,700 annually based on full-time employment. We comply with all minimum wage laws as applicable.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
