North American Medical Management, California, Inc (NAMM California) partnered with UnitedHealth Group in 2012. As one of the largest insurers in the United States, UnitedHealth Group provides a professional culture where you're empowered and encouraged to exceed the expectations of our members, with better schedules than retail and more reach than any hospital. Join us and start doing your life's best work.(sm)
As a part of our continued growth, we are searching for a new Director of Clinical Pharmacy to join our team.
The Director of Clinical Pharmacy will assume a leadership role in the planning, development and implementation of pharmacy and disease management programs and processes that result in decreased hospital and emergency room utilization, improved patient care, and maximize Pay for Performance revenue. This role will be accountable for planning, developing and implementing physician education programs related to new treatment modalities for various disease states, HEDIS / P4P, CMS Star Ratings, Medicare Part B and & D drugs, and pharmacy utilization management best practices.
Will participate in Joint Operating and Medical Management Committees, designs and implements cost / utilization and trend analysis reports for pharmacy utilization - provided by health plans, including recommendations for physicians
Manages daily authorizations for appropriateness of various injectable drugs, IV solutions, and chemotherapy, including the development of policies and procedures for appropriate optimal cost savings treatment plans
Identifies potential vendors and assists the Network Management Department with contract negotiations as well as negotiates best possible rates based on Drug class and member specificity
Serves as a clinical / pharmacy subject matter expert for Clinical Service’s case managers including identifying high volume / high cost pharmacy utilizing members and assisting with the development of case management planning
Co - leads the development and implementation of Disease Management Programs, (CHF, COPD, Diabetes, Renal, HTN) oversees the day-to-day program processes, and chairs the Disease Management Subcommittee
Participates in the Clinical Services Medical Management Team and collaborates with the CMO, Medical Directors and Clinical Directors in all strategic planning, including establishing annual departmental goals and objectives
In partnership with Medical Directors, identifies areas of over or under pharmacy utilization, often through collaboration with finance and decision support departments. In conjunction with the CMO and the Clinical Services Medical Management Team develops and implements corrective action plans resulting in required process changes and outcomes when aberrant trends are identified
Consistently supports compliance by maintaining the privacy and confidentiality of information, protecting the assets of the organization, acting with ethics and integrity, reporting noncompliance, and adhering to applicable federal, state and local laws and regulations, accreditation and license requirements (if applicable), and current MHC policies and procedures
Manages direct reports by overseeing individual business and development goals, performing and entering annual performance reviews, managing staff reimbursement and other departmental budgetary issues as needed
Serves as liaison and channel of communication for Pharmacy related issues between the CMO and committees, external customers and organizations, and the medical and administrative staff
Pharm D degree
Active, unrestricted Pharmacist license in California
2+ years of Clinical Pharmacy Experience with IPAs, medical groups or in a direct patient contact role (inpatient/ambulatory care)
2+ years of Pharmacy Benefit Management exp (PBM)
2+ years of supervisory experience
Strong working knowledge of Medicare Part B and Medicare Part D
Computer proficiency in MS Office: Excel and PowerPoint
Strong presentation skills
Experience with IPAs, medical groups or HMOs
Completion of an accredited ASHP PGY1 Residency
NAMM, a segment of OptumHealth is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system.
OptumHealth helps nearly 60 million Americans live their lives to the fullest by educating them about their symptoms, conditions and treatments; helping them to navigate the system, finance their health care needs and stay on track with their health goals. No other business touches so many lives in such a positive way. And we do it all with every action focused on our shared values of Integrity, Compassion, Relationships, Innovation & Performance.
At OptumHealth, you will perform within an innovative culture that's focused on transformational change in the health care system. You will leverage your skills across a diverse and multi-faceted business. And you will make contributions that will have an impact that's greater than you've ever imagined.
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer 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.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.