Director of Clinical Pharmacy Medical Management

    • San Antonio, TX

Position Description

Do you have compassion and a passion to help others? Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieve your life's best work.(sm)

WellMed provides concierge - level medical care and service for seniors, delivered by physicians and clinic staff that understand and care about the patient's health. WellMed's proactive approach focuses on prevention and the complete coordination of care for patients. WellMed is now part of the Optum division under the greater UnitedHealth Group umbrella.

Under the direction of the VP of Medical Management Pharmacy Programs, the Director of Pharmacy will be responsible for the coordination of all UM pharmacy programs with the Medical Management leaders to ensure appropriate medication review and cost effectiveness. This position will collaborate with the Regional Medical Directors, market and care management leaders to improve QI metrics related to medication management and serve as a co-chair for the Medical Management P&T Committee.

Primary Responsibilities:

  • Assumes a leadership role in planning and implementation of UM pharmacy programs and initiatives.
  • Review specialty medication prior authorization requests (i.e. biopharmaceuticals) according to established treatment protocols, clinical criteria and member benefits. and make determinations within the defined turnaround times and meet regulatory requirements
  • Manage and coach the direct reporting individuals in the Pharmacy Department.
  • Manages and updates the specialty/Part B injectable drug review policies and procedures to ensure compliance with CMS requirements.
  • Manages the specialty pharmacy sourcing for injectable drugs.
  • Serve as a co-chair on the Medical management P&T Committee.
  • Develops and implements clinical cost of care strategies for auditing of B vs. D claims in coordination and collaboration with UM, claims and configuration department.
  • •Develops and implements clinical cost of care strategies and quality initiatives as needed to help reduce pharmacy cost and utilization
  • Read, analyze, and interpret common scientific and technical journals, financial reports, and legal documents.
  • Respond to inquiries or complaints from customers or members of the business community and effectively present 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.
  • Communicate effectively with key external constituents as needed (clinics, physician group, hospital) regarding pharmacy program, preferred drug list and pharmacy processes.
  • Support health plan initiatives that include pharmacy components.
  • Serves as a clinical resource and consultant in all areas of pharmacy and medication management.
  • Supports medical management and clinical/quality initiatives across the organization
  • 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
  • Completes significant special projects and performs all other related duties as assigned

Required Qualifications:

  • Doctor of Pharmacy degree
  • Current, unrestricted Pharmacist license in TX or the ability to provide proof of licensure within 90 days from date of employment
  • 3 years of management experience
  • 5+ years of experience as Clinical Pharmacist
  • 3+ years of experience with Medicare Part B programs
  • A bility to manage multiple, complex, concurrent projects
  • Excellent written and verbal communication, relationship building skills
  • Strong interpersonal skills, ability to work independently, and as a key member of a team
  • Experience working with provider relations, payer environments and risk management
  • Proficient with Microsoft Word, PowerPoint, Outlook, Excel
  • Ability to travel as necessary

Preferred Qualifications:

  • Board certification by the Board of Pharmacy Specialties (BPS)
  • Certified Geriatric Pharmacist

Careers with WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 350,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi - specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team 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.

Keywords: Pharmacist, Management, Clinical Director, WellMed, UM pharmacy. Medical Management, PharmD

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