Director, Clinical Pharmacy

UnitedHealth   •  

San Antonio, TX

Industry: Insurance

  •  

Less than 5 years

Posted 394 days ago

Primary Responsibilities:

  • Lead the planning and implementation of pharmacy programs and initiatives
  • Manage and coach the direct reporting individuals in the Pharmacy Department
  • Update and maintain pharmacy program policies and procedures to ensure compliance with CMS requirements
  • Reads, analyzes, and interprets common scientific and technical journals, financialreports, and legal documents
  • Responds to inquiries or complaints from customers or members of the business community and effectively presents information to top management and/or external constituents
  • Communicate effectively with key customers (health plans etc.) to keep them informed of pharmacy programs and initiatives
  • Communicates effectively with key external constituents as needed (clinics, physician group, hospital) regarding pharmacy program, preferred drug list and pharmacy processes
  • Provides routine, timely and accurate communication to health plan management regarding pharmacy programs, cost issues, utilization issues, budget performance, etc.
  • Supports health plan initiatives that include pharmacy components
  • Serves as a clinical resource and consultant in all areas of pharmacy and medication management
  • Develops and implements clinical cost of care strategies and quality initiatives as needed to help reduce pharmacy cost and utilization
  • Supports medical management and clinical/quality initiatives across the organization
  • Manages injectable drugs under Part B by developing medical necessity policies for key injectable drugs, management of the specialty pharmacy sourcing for injectable drugs
  • Develops and implements clinical cost of care strategies for auditing of B vs. D claims in coordination and collaboration with claims and configuration
  • Manages relationships with Physician Business Managers (PBMs) to ensure information is shared with providers for improvement of utilization and quality
  • Participates in QI and other committee meetings as appropriate
  • Travels for business up to 25% either in the TX market or to FL market
  • Completes significant special projects and performs all other related duties as assigned


Requirements

To be considered for this position, applicants need to meet the qualifications listed in this posting.

Required Qualifications:

  • Doctor of Pharmacy degree
  • Active, unrestricted pharmacy license in Texas
  • 2+ years of supervisory/management experience
  • 3+ years of experience with Medicare Part D programs required
  • Ability to manage multiple complex, concurrent projects
  • Excellent written and verbal communication and relationship building skills
  • Planning and organizational skills to demonstrate leadership and initiative
  • Strong interpersonal skills. Ability to work independently, as well as a member of a team
  • Proficient with Microsoft Word, Excel, Outlook, PowerPoint
  • Experience working with provider relations, working within various payor environments, and risk management
  • Ability to travel up to 25% in the TX or FL market

Preferred Qualifications:

  • Board certification by the Board of Pharmacy Specialties (BPS)
  • Certified Geriatric Pharmacist

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