UnitedHealth Group Clinical Pharmacist, Quality – Telecommute/Field from Schaumburg, Illinois in Schaumburg, Illinois

At OptumRx, a part of the UnitedHealth Group family of businesses and one of the largest pharmacy benefits managers in the United States, we're dispensing with tradition. Join us as we take on the challenge of reinventing the health system.

The Clinical Pharmacist, Quality 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.

If you are located in Schaumburg, Illinois , you will have the flexibility to telecommute* as you take on some tough challenges.

Primary Responsibilities:

  • Achieve market specific goals for medication-dependent measures through a comprehensive pharmacy strategy that supports overall plan strategy to achieve goals

  • Develop, implement, and assess statewide initiatives for members in the plan using data driven analytics based on the needs of the territory and contract to drive provider performance

  • Initiatives plans should include

  • Education, tools, and tracking system for QFO

  • Targets (specific members, providers, etc.)

  • Expected results

  • Reporting format and cadence to market and plan leadership.

  • Functioning independently, travel within assigned states 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

  • Responsible for preceptorship and oversight of Pharmacy student(s) at local office & to accompany student(s) during provider visits.

  • 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 on Part D measures: Medication adherence, CMRs and SUPD

  • Engage and collaborate with pharmacies; primarily independent pharmacies across the state, to drive medication adherence for all 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 local market events 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% travel at times based on seasonal peaks

This position will require the employee to work in the Schaumburg office a maximum of 20% of the time. The other time in the role will be spent at various providers offices, pharmacies and telecommuting from home.

Monday-Friday, days

Required Qualifications:

  • BS in Pharmacy or PharmD

  • Current, unrestricted Pharmacist license in Illinois

  • 3+ years of experience working as a Licensed Pharmacist

  • 3+ years of direct experience working to close quality measurement gaps and strong working knowledge of clinical standards of care, preventive health, and Stars measures

  • 1+ year of Medicare experience

  • MTM experience with platforms such as Outcomes and Mirixa

  • Proficiency with Microsoft Word, Excel, Outlook and PowerPoint

  • Ability to travel up to 25%

Preferred Qualifications:

  • Pharm D degree

  • Stars or HEDIS experience

  • 3+ years of Pharmacist experience within a health plan or managed care

  • Provider, client and/or member-facing experience

  • Experience working with network and provider relations/contracting

  • Experience with electronic medical record systems

  • Consulting experience

  • Data analytics experience

Join us and use your diverse knowledge and experience to make health care work better for our patients. Discover a path to your life's best work.(sm)

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world?s large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy

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, Pharm D, MTM, telecommute, Schaumburg, Illinois