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Director, Clinical Pharmacy - Monarch HealthCare - Irvine, CA

UnitedHealth Group

Irvine, CA
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Job Details

731412 Director Clinical Pharmacy

Director, Clinical Pharmacy - Monarch HealthCare - Irvine, CA (731412)

Position Description

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 Director of Clinical Pharmacy will assume a leadership role in the planning, development and implementation of pharmacy and disease management programs and processes that result in decreased hospital and emergency room utilization, improved patient care, and maximize Pay for Performance revenue.  This role will be accountable for planning, developing and implementing physician education programs related to new treatment modalities for various disease states, HEDIS / P4P, CMS Star Ratings, Medicare Part B and & D drugs, and pharmacy utilization management best practices.


Primary Responsibilities:

  • In collaboration with Medical Directors, executes and implements intervention strategies at various physician practices to manage pharmacy utilization related to pharmacy risk pools and generic incentive programs

  • Will participate in Joint Operating and Medical Management Committees, designs and implements cost / utilization and trend analysis reports for pharmacy utilization - provided by health plans, including recommendations for physicians

  • Manages daily authorizations for appropriateness of various injectable drugs, IV solutions, and chemotherapy, including the development of policies and procedures for appropriate optimal cost savings treatment plans

  • Identifies potential vendors and assists the Network Management Department with contract negotiations

  • Serves as Co-Chair of Monarch Pharmacy & Therapeutics (P&T) Committee

  • Serves as a clinical / pharmacy subject matter expert for Clinical Service’s case managers including identifying high volume / high cost pharmacy utilizing members and assisting with the development of case management planning

  • Collaborates with High Risk Touch Teams to ensure effective medication reconciliation and patient education for high risk patients in order to decrease readmissions and avoidable emergency room visits

  • Contributes as valuable contributor for the Quality Improvement Committee, Utilization Management Committee, and other meetings such as Credentialing and Peer Review Committee, Readmission Rounds, Fee For Service Committee, ER Subcommittee, Vaccine Subcommittee, and MCR Committee as requested

  • Co - leads the development and implementation of Disease Management Programs, (CHF, COPD, Diabetes, Renal, HTN) oversees the day-to-day program processes, and chairs the Disease Management Subcommittee

  • In collaboration with Medical Directors, develops performance metrics

  • Tracks and trends outcomes and designs and / or implements operational changes to affect performance of each Program

  • Maintains a working knowledge of changes in pharmacy practice, including pharmacy laws and drugs, and applies this knowledge in the performance of daily activities

  • Identifies opportunities for improvement and provides additional orientation, training and skill development to internal staff and external customers on an ongoing basis

  • Participates in the Clinical Services Medical Management Team and collaborates with the CMO, Medical Directors and Clinical Directors in all strategic planning, including establishing annual departmental goals and objectives

  • Under the direction of the CMO and in collaboration with the Medical Directors and Clinical Affairs Directors, develops and coordinates the implementation of Pharmacy medical management processes, policies and procedures to assure that medically necessary services are delivered in an optimally cost and quality efficient manner

  • In partnership with Medical Directors and Clinical Affairs Directors, identifies areas of over or under pharmacy utilization, often through collaboration with finance and decision support departments. In conjunction with the CMO and the Clinical Services Medical Management Team develops and implements corrective action plans resulting in required process changes and outcomes when aberrant trends are identified

  • Promotes a culture of open, clear communication and collaboration interdepartmentally and intra - departmentally and with external customers and organizations

  • Consistently supports compliance by maintaining the privacy and confidentiality of information, protecting the assets of the organization, acting with ethics and integrity, reporting noncompliance, and adhering to applicable federal, state and local laws and regulations, accreditation and license requirements (if applicable), and current MHC policies and procedures

  • Contributes to planning efforts as needed, and attends and / or participates in community Health Fairs

  • Manages direct reports by overseeing individual business and development goals, performing and entering annual performance reviews, managing staff reimbursement and other departmental budgetary issues as needed

  • Serves as liaison and channel of communication for Pharmacy related issues between the CMO and committees, external customers and organizations, and the medical and administrative staff


Required Qualifications:

  • Pharm D degree

  • Active, unrestricted Pharmacist license in California

  • 5+ years of managed care medical management experience

  • 3+ years of supervisory experience

  • Strong working knowledge of Medicare Part B and Medicare Part D


 Preferred Qualifications:

  • Experience with IPAs, medical groups or HMOs

  • Completion of an accredited ASHP PGY1 Residency 

What is the first thing that happens when one of the most successful physician groups in Orange County comes together with a global leader in health care? Monarch HealthCare joining OptumCare and the UnitedHealth Group family of companies, people like you will find increasing levels of challenge, impact and professional success. With a vibrant network of hospitals and urgent care centers, we're changing health care for the better by improving access to affordable, high quality care, and working together to improve the patient experience. That takes passion, commitment, intense focus and the ability to contribute effectively in a highly collaborative team environment. Are you with us? Learn more about this exciting opportunity to do your life's best work.(sm)


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.



Job Keywords: Medical Management, Clinical, Licensed Pharmacy, Pharmacist, Pharm D, Medicare

Job Details

  • Contest Number731412
  • Job TitleDirector, Clinical Pharmacy - Monarch HealthCare - Irvine, CA
  • Job FamilyPharmacy
  • Business SegmentOptumCare

Job Location Information

  • Irvine, CA
    United States
    North America

Additional Job Detail Information

  • Employee StatusRegular
  • ScheduleFull-time
  • Job LevelDirector
  • ShiftDay Job
  • TravelNo
  • Telecommuter PositionNo
  • Overtime StatusExempt

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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