Pharmacy Director - Remote in Ohio - Community and State

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.

Providing outstanding service to our Medicaid Health plans and members takes a solid mix of business skills, technical expertise, industry knowledge, and clinical fortitude.

The Pharmacy Director for the Ohio Medicaid Health Plan is responsible for the execution, administration, and oversight of the drug benefits, operations, programs, and initiatives that align with company goals, comply with contractual and regulatory obligations, and ensure that Medicaid members have timely access to affordable care and services. The Pharmacy Director provides strategic, financial, clinical, relationship, and organizational leadership for the Medicaid health plan, its leadership team, and stakeholders. The role exercises broad strategic and operational oversight for planning, organizing, and directing all aspects of pharmacy and drug benefit programs, including clinician administered drugs and programs, preferred drug list(s) or formulary design and maintenance, utilization reviews, reporting & analytics, and quality initiatives. In partnership with Health Plan leaders and Shared Services, the Pharmacy Director is responsible to manage and oversee the pharmacy benefits manager (PBM) contractual accountabilities, benefit operations, service levels, and escalations for their Health Plan.

If you are located in the state of Ohio and able to travel about 10% of the time, you'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Utilize deep and broad understanding of managed care, health plan operations, and PBM knowledge to develop, execute, and drive strategic plans and goals while ensuring compliance with the state contract and/or state/federal statutes and regulations
• Work cross-functionally across departments to ensure timely implementation of benefit changes, regulatory requirements, and cross-departmental initiatives with providers, members, and other stakeholders to achieve business and clinical outcomes
• Develop, implement/execute, and oversee the drug benefit including formulary management, administration, monitoring, reporting, communication, clinical programs, and utilization management strategies for pharmaceuticals, including clinician administered drugs
• Partner with the PBM account team to coordinate Plan specific PBM pharmacy requirements and resolve implementation issues and ongoing operational issues through root cause analyses, resolution execution, and continuous quality improvement disciplines
• Analyze, review, and present pharmacy/drug financials, drug rebates, forecast, and trend information for operational and business planning (short and long term)
• Conduct financial impact analysis and cost-benefit analysis (CBAs) to inform decision-making, enhance strategic roadmap(s), and align/accelerate company and health plan priorities
• Build and maintain solid relationships with internal cross department partners and serve as the primary point of contact for Plan pharmacy/drug services
• Create and maintain state specific polices, programs, collaterals, artifacts, etc.
• Serves as the Plan SME single point of contact for formulary, prior authorization, and benefit coding requirements and execution and responsible for communication with stakeholders for implementation
• Have a solid working knowledge of health plan operations (compliance, finance, encounters, claims adjudications, networks, clinical, case management, HEDIS measures, etc.) to develop and analyze efficiency and quality metrics and improves performance on a continuous basis
• Collaborate with internal partners to identify, prioritize, and execute key growth, innovative projects, member and provider experience and affordability opportunities to address on-going needs of the plan, Medicaid members, and providers
• Collaborate with shared services partners to provide content and proof points to support Requests for Proposals (RFP), bids, and competitive market checks on the PBMs and competitors as circumstances dictate
• Monitor under and over-utilization of pharmaceuticals and identify opportunities for cost-effective alternatives, vendor administration, and quality improvement through approved/denied claims, prior authorization volume, and step therapy effectiveness with timely claims review to ensure appropriate adjudication at point of sale
• Coordinate production and submission of timely reports and data analytics as required for, but not limited to, all drug benefits and services, compliance dashboard, regulatory requirements, productivity, clinical operations, benefit changes, implementation, and service quality monitoring, etc. as required by health plan, Medicaid Agency, regulators, auditors, etc.
• Assist Health Services team, Medical Directors, and other health plan partners with activities to meet departmental and organization objectives and implementing action plans to address issues and improve key performance indicators and select utilization, economic, and quality outcomes
• Communicate drug program changes with all impacted external and internal parties
• Engage with State Medicaid, pharmacy and health plan Associations, and other key stakeholders to strengthen relationships
• Attend the Agency Pharmaceutical & Therapeutics (P&T) Committee and Drug Utilization Review (DUR) Commission meetings, and other forums as requested
• Support health plan partners to ensure timely resolution of pharmacy/drug related issues, advance advocacy efforts, and foster deeper collaborations with the state
• Learns, understands and lives the United cultural values
• Other duties as assigned

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.

Required Qualifications:

• Current, unrestricted Registered Pharmacist license and residing in Ohio
• 3+ years of progressively responsible and direct work experience of Clinical Pharmacy, Sales, or Account Management experience or combination thereof with the duties and responsibilities as described above OR a minimum of 2 years of experience in Managed Care Health Plan or PBM or Managed Care Pharmacy residency
• Direct experience with Medicaid/Medicare plans
• Intermediate to advance proficiency in Microsoft Office Suite, including Word, Excel and PowerPoint
• Advance analytics and data skills, with experience and knowledge of pharmacy/medical analytics and health economics outcomes research
• Experience with government contracts/programs in a PBM or health plan
• Knowledge of medical drug CPT/HPCS coding
• Solid clinical knowledge and ability to interpret evidence-based guidelines, complex clinical information, claims data, and regulatory requirements to deliver product and program development solution
• Ability to effectively facilitate meetings and deliver information/presentations to management, regulators, or partners
• Ability to direct, implement, and manage large-scale, complex, cross-functional, multi-departmental projects to completion, with performance (leading and lagging) KPIs, and minimum supervision
• Ability to think critically, creatively, and work strategically, to help drive innovative solutions yielding measurable results to the organization
• Ability to travel locally 10% of the time based on business needs
• Driver's license and access to reliable transportation

Preferred Qualifications:

• Pharm D

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

The salary range for this role is $106,800 to $194,200 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with al minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives.

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.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.