1+ months

Director of Clinical Pharmacy Medical Management

San Antonio, TX 78205
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  • Jobs Rated
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



Jobs Rated Reports for Pharmacist

Posted: 2020-06-29 Expires: 2020-08-28

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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Director of Clinical Pharmacy Medical Management

UnitedHealth Group
San Antonio, TX 78205

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

Work Environment
Very Low
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