Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Come make an impact on the communities we serve as we help advance health equity on a global scale. Here, you will find talented peers, comprehensive benefits, a culture guided by diversity and inclusion, career growth opportunities and your life's best work.(sm)
The individual will be an integral member of pharmacy services directly impacting the utilization management of specialty injectables and high cost medications. Under the priorities of improving quality and driving value based prescribing, this individual will collaborate with cross functional colleagues to deliver value based care.
Primary functions entail managing utilization of injectable medications and specialty pharmaceuticals
Implement and coordinate strategies to control specialty pharmacy utilization and cost
Coordinate operational processes with specialty pharmacy vendors
Execute strategies to educate physicians/providers, including methods to measure and monitor the effectiveness and success of all pharmacy programs and services that are implemented. (Must have strong verbal and written communication skills and the ability to influence using evidence based data.)
Participate as an internal clinical consultant on clinical effectiveness, safety, and value data to physicians and colleagues, in all matters relating to pharmaceuticals
Complete utilization management reviews within regulatory and policy-specified turnaround times, and align with UM medical directors to ensure accuracy, and evidence-based determinations
Maintain ongoing competence level on utilization management policies and training
Monitor and report trends on work output which will entail providing guidance and collaborating with analysts to ensure accurate collection and reporting of pharmacy utilization data
Support Pharmacy and Therapeutics Committee (P&T) meetings. Develop scientific content related to drug reviews and guidelines relevant to utilization management programs. Communicates treatment guidelines and policies to the physicians/providers to ensure that physician/provider behavior change is consistent with the goals of the P&T committee
Monitor new drug approvals, drug launches and pipeline drugs (specialty and biosimilars)
Research and analyze drugs and emerging therapeutics, monitor relevant publicly available news/developments in the pharmaceutical sector, perform any related ad .hoc analyses and generate insights
Develop communications and communicate effectively with cross functional colleagues regarding trends, accomplishments, and other data parameters prioritized by the director
Present confidently to leadership on key metrics including affordability initiatives, generic/biosimilar drug pipeline savings and potential drug pipeline impacts
Other duties as assigned by the director of pharmacy services
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.
Graduate from an accredited school of pharmacy
California State Pharmacy License and Pharm.D
3+ years of experience in clinical pharmacy practice including:
Disease state management and drug use evaluations
Reviewing coverage determinations and appeals
Formulary and drug information resource
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
Advanced Practice Pharmacist (Aph) License
Board certification in pharmacy specialties
Managed care experience
ASHP-accredited residency in Pharmacy Practice or equivalent background/experience
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. Our objective is to make health care simpler and more effective for everyone. With our hands at work across all aspects of health, you can play a role in creating a healthier world, one insight, one connection and one person at a time. We bring together some of the greatest minds and ideas to take health care to its fullest potential, promoting health equity and accessibility. Work with diverse, engaged and high-performing teams to help solve important challenges.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.
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.