OptumCare Network of Utah is a network of local doctors, hospitals and specialists to help patients make well - informed decisions about their healthcare. The Clinical Pharmacy and Quality Teams provide a variety of clinical services impacting Medical Management and CMS Stars Rating quality initiatives. The Network Clinical Pharmacist will be overseeing initiatives on provider education and strategy to improve performance for medication - related HEDIS measures, including but not limited to, medication adherence, MTM - CMR, and medication reconciliation post - discharge.
The team comprises of clinical pharmacists, certified pharmacy technicians, and clinical quality Registered Nurses that complete various functions to successfully meet the operational requirements of each clinical service. The work hours required will be during normal business hours, Monday through Friday.
The Network Clinical Pharmacist will be primarily responsible for performance of assigned provider group HEDIS performance, working to ensure a 4+ Star rating.
- Positions in this function provide clinical pharmacy guidance and support on any or all of the following:
- Quality of care programs, including HEDIS and CMS Stars programs, to contracted network providers
- Develop and collaborate on member and/or provider collateral materials for pharmacy programs
- Develop and execute provider strategy to ensure 4+ Star rating
- Provider physician education on medication-related measures, guidelines, and medication updates as necessary
- Review programs for compliance to state, federal and CMS regulations. Monitor impending legislation for potential impact to current and future programs
- Perform quality audits, determine performance gaps and root causes, prepares reports and collaborates on remediation
- Engage with primary care providers to ensure medication alignment, adherence, and optimal therapy for empaneled membership
- BS in Pharmacy or PharmD degree
- Current and unrestricted pharmacist licensure in state of Utah
- 4+ years of experience in a clinical setting or completion of a residency program
- Experience teaching, training, and presenting clinical information to a variety of audiences
- Microsoft Office Proficiency
- Local travel to provider sites to conduct data abstraction as needed. Up to 25 - 50% local travel
- Access to reliable transportation that will enable you to travel to client sites within a designated area
- PharmD degree
- Board Certification (ie: BCPS, BCACP)
- Clinical quality experience (e.g. HEDIS, Stars, NCQA)
- Experience with Medicare Advantage