Network Quality and Affordability Clinical Pharmacist - Draper, UT
Location: Draper, Utah
Internal Number: 117505567
Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that is improving the lives of millions. Here, innovation is not about another gadget; it is about making health care data available wherever and whenever people need it, safely and reliably. There is no room for error. If you are looking for a better place to use your passion and your desire to drive change, this is the place to be. It's an opportunity to do your life's best work.(sm)
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
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.
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
Expertise analyzing business data and trends to identify new opportunities for business growth and improvement in provider/member experience
3+ years of experience in two of the following: data analysis and reporting, project management, program management, consulting, managing affordability initiatives or clinical programs
Experience with Medicare Advantage
Experience teaching, training, and presenting clinical information to a variety of audiences
Experience presenting strategic and performance level information to large audiences including senior executives
Expertise influencing to drive decision-making
Experience in delivering on multiple operational projects/initiatives along with collecting and synthesizing data for accurate, scalable, and actionable reporting
Documentation experience including project plan, business requirements, SOPs, process flows, along with the ability to produce and present compelling reports and collateral to support program growth to management
Proficiency with Microsoft Office - Advanced Power Point and Excel skills
Willingness to travel if needed
Access to reliable transportation that will enable you to travel to client sites within a designated area
Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation
Experience with Care Delivery Organizations or health systems
Experience with affordability programs, DMEPOS, Payment Integrity, Finance, Palliative Care, SDOH, ER Diversion, Behavioral Health, Value Based Care, Facility Based Care, SNF, Specialty Pharmacy, or Rx Operations
To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)
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.