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Director, Clinical Pharmacy Ops - San Antonio, TX **$6K Sign-On Bonus**

UnitedHealth Group

San Antonio, TX
Job Code:
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Job Details

Director, Clinical Pharmacy Ops - San Antonio, TX **$6K Sign-On Bonus**(Job Number:717095)

Under the direction of the VP of Pharmacy Program, the Clinical Pharmacy Director will be responsible for the coordination of all pharmacy programs with the Medical Management leaders to ensure appropriate medication use and cost effectiveness. This position will collaborate with the Regional Medical Director, market and care management leaders to improve QI metrics related to medication management; manages the coordination, implementation and communication of the Medication Assistance Program (MAP) for WellMed.
Primary Responsibilities:
  • Lead the planning and implementation of pharmacy programs and initiatives
  • Manage and coach the direct reporting individuals in the Pharmacy Department
  • Update and maintain pharmacy program policies and procedures to ensure compliance with CMS requirements
  • Reads, analyzes, and interprets common scientific and technical journals, financial reports, and legal documents
  • Responds to inquiries or complaints from customers or members of the business community and effectively presents 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
  • Communicates effectively with key external constituents as needed (clinics, physician group, hospital) regarding pharmacy program, preferred drug list and pharmacy processes
  • Provides routine, timely and accurate communication to health plan management regarding pharmacy programs, cost issues, utilization issues, budget performance, etc.
  • Supports health plan initiatives that include pharmacy components
  • Serves as a clinical resource and consultant in all areas of pharmacy and medication management
  • Develops and implements clinical cost of care strategies and quality initiatives as needed to help reduce pharmacy cost and utilization
  • Supports medical management and clinical/quality initiatives across the organization
  • Manages injectable drugs under Part B by developing medical necessity policies for key injectable drugs, management of the specialty pharmacy sourcing for injectable drugs
  • Develops and implements clinical cost of care strategies for auditing of B vs. D claims in coordination and collaboration with claims and configuration
  • 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
  • Travels for business up to 25% either in the TX market or to FL market
  • Completes significant special projects and performs all other related duties as assigned

Job Pharmacy Operations
Primary Location US-TX-San Antonio
Other Location 
Organization WellMed Medical Mgmt, Inc
Schedule Full-time
Number of Openings 1
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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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