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Network Quality and Affordability Clinical Pharmacist - Draper, UT




Draper, Utah, United States

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)

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.

Primary Responsibilities:

  • 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.

Required Qualifications:

  • BS in Pharmacy or PharmD degree
  • Current and unrestricted pharmacist licensure in state of Utah
  • 3+ years of experience in a clinical setting or completion of a residency program
  • 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
  • Proficiency with Microsoft Office - Advanced Power Point and Excel skills
  • Willingness to travel within Utah Valley 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

Preferred Qualifications:

  • PharmD degree
  • Board Certification (ie: BCPS, BCACP)
  • Clinical quality experience (e.g. HEDIS, Stars, NCQA)
  • 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 Structured Query Language (SQL)
  • 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
  • Expertise analyzing business data and trends to identify new opportunities for business growth and improvement in provider/member experience
  • Experience with Medicare Advantage
  • Experience teaching, training, and presenting clinical information to a variety of audiences

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 at OptumCare. We're on a mission to change the face of health care. As the largest health and wellness business in the US, we help 58 million people navigate the health care system, finance their health care needs and achieve their health and well-being goals. Fortunately, we have a team of the best and brightest minds on the planet to make it happen. Together we're creating the most innovative ideas and comprehensive strategies to help heal the health care system and create a brighter future for us all. Join us and learn why there is no better place to do your life's best work.(sm)

OptumCare is committed to creating an environment where physicians focus on what they do best: care for their patients. To do so, OptumCare provides administrative and business support services to both owned and affiliated medical practices which are part of OptumCare. Each medical practice part and their physician employees have complete authority with regards to all medical decision-making and patient care. OptumCare’s support services do not interfere with or control the practice of medicine by the medical practices or any of their physicians.

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.