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


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