26 days old

Clinical Quality Pharmacist - Alabama Telecommute

Birmingham, AL 35203
  • Job Code
    853121
  • Jobs Rated
    33rd

As one of the largest pharmacy benefits managers in the United States, UnitedHealth Group provides a professional culture where you're empowered and encouraged to exceed the expectations of our members, with better schedules than retail and more reach than any hospital. Join us and start doing your life's best work.(sm)

 

The Clinical Quality Pharmacist is responsible for engaging our network providers and local pharmacies in discussions related to Part D quality measures and programs primarily for our Medicare and Retirement business.  Performance management is tracked by designated provider metrics, inclusive minimally of 4 STAR gap closure and improved quality. The person in this role is expected to work directly with our clinical quality team, providers and pharmacies to build relationships, ensure effective education and share reporting specifically focused on Part D measures. They will proactively identify performance improvement opportunities through data analysis and discussion with subject matter experts; and influence provider behavior to achieve needed results.

 

Primary Responsibilities:

  • Functioning independently, travel across state of Alabama to meet with providers to discuss Optum and UHC tools and programs focused on improving the quality of care for Medicare Advantage Members specifically focusing on medication adherence and high risk medications
  • Strategize with our Optum and United HealthCare quality team in the development of training and analytical materials for Stars and HEDIS, with a primary focus of medication adherence
  • Engage and collaborate with pharmacies; including the independent pharmacies across the state, to improve medication adherence of Medicare Advantage Members
  • Establish positive, long-term, consultative relationships with physicians, medical groups, IPAs and ACOs
  • Develop comprehensive, provider-specific plans to increase their HEDIS and Part D performance and improve their outcomes
  • Participate in Clinic days to address members with multiple gaps and perform medication reconciliations
  • Provide ongoing strategic recommendations, training and coaching to provider groups and pharmacies on program implementation and barrier resolution
  • Act as lead to pull necessary internal resources together in order to provide appropriate, effective provider education, coaching and consultation; training will include Stars measures (HEDIS/CAHPS/HOS/med adherence), Optum program administration, and use of plan tools, reports and systems
  • Provide reporting to health plan leadership on progress of overall performance of pharmacy measures, gap closure, and use of virtual administrative resource
  • Facilitate/lead monthly or quarterly meetings, as required by plan leader, including report and material preparation
  • Provide suggestions and feedback to Optum and health plan
  • Provide clinical knowledge to our providers of chronic disease states in particular diabetes, hypertension and hyperlipidemia and changes in pharmacy practice in adult and geriatric patient populations to serve as an authoritative information source on drugs and their utilization in therapy
  • Deliver high quality evidence-based therapeutic recommendations to providers
  • Work collaboratively with health plan market leads to make providers aware of Plan-sponsored initiatives designed to assist and empower members in closing gaps
  • Role includes up to 75% state-wide travel
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Posted: 2019-11-14 Expires: 2019-12-14

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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Clinical Quality Pharmacist - Alabama Telecommute

UnitedHealth Group
Birmingham, AL 35203

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Pharmacist
33rd2018 - Pharmacist
Overall Rating: 33/220
Median Salary: $124,170

Work Environment
Good
59/220
Stress
Very Low
43/220
Growth
Poor
168/220
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