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Sr Director, Clinical Quality- OptumRx Irvine, CA/Schaumburg, IL

UnitedHealth Group

Schaumburg, IL
Job Code:
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Job Details

Sr Director, Clinical Quality- OptumRx Irvine, CA/Schaumburg, IL(Job Number:721710)

The Senior Director of Clinical Quality  will oversee and set the strategic direction for OptumRx’s Clinical Quality Management program, encompassing numerous areas which include, but are not limited to: Formulary/UM, Clinical Data / Analytics / Reporting, Drug Intelligence Services, Clinical Consulting, MTM, Prior Authorization and other Clinical Products and Services.
Primary Responsibilities:
  • Determine strategic direction for Clinical Quality Mgmt (quality of care, compliance and Quality Improvement), PBM, Mail and Specialty Accreditation and Health Plan Delegation Services (e.g., URAC, NCQA, etc…), Clinical Policy & Procedures, and Clinical Performance Metric Development, Refinement and Monitoring.
  • Continual development, implementation and evaluation of new and current Clinical Quality Oversight Programs and associated reporting metrics and outcomes
  • Maintain close working relationships / dialogue with key customers (internal and external) to help ensure optimal quality and compliance in clinical products and services.
  • Assist clinical teams in the development of key QI and QA processes and metrics; training and monitoring
  • Lead / chair activities of a Clinical Quality Oversight Committee; Monthly MTM Review; Monthly Clinical PA / Appeals Review
  • Serve as an active participant in various other cross-departmental committees / meetings where clinical quality representation is essential (e.g., Specialty QM; Med D Guidance; Operational Policy Mgmt; Clinical Utilization Mgmt; Med D Audit, etc…)
  • Oversee quality monitoring of external clinical vendor activity (e.g., contracted IROs) to ensure optimal quality and compliance with their subcontracted functions
  • Work closely with OptumRx Government Relations team to ensure that clinical programs comply with federal and state regulations, partnering with program owners to develop policy, programs, and processes as needed
  • Oversee, on an as needed basis, the collaborative research and formal addressing of clinical Quality of Care issues including development and communication of corrective action plans as needed 
  • Manages and provides oversight to clinical staff (5)
  • Reports regularly to senior leadership on quality improvement initiatives and recommendations

Job Pharmacy Clinical Programs
Primary Location US-IL-Schaumburg
Other Location US-CA-Irvine
Organization OptumRx Pharmacy Svcs
Schedule Full-time
Number of Openings 1
Apply on the Company Site

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