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OptumRx Director Clin Quality, Schaumburg IL/Irvine CA

UnitedHealth Group

Schaumburg, IL
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Job Details

737118 Senior Director of Clinical Quality SchaumburgIrvine

OptumRx Director Clin Quality, Schaumburg IL/Irvine CA (737118)

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 Senior Director of Clinical Quality  will oversee and set the strategic direction for implementation of and reporting out on OptumRx Clinical Quality Management program, encompassing numerous areas which include, but are not limited to: Prior Authorization, MTM,  Clinical Data / Analytics / Reporting, Drug Intelligence Services, Formulary / UM and other Clinical Products and Services.


Primary Responsibilities:

  • Determine strategic direction for Clinical Quality Management (quality of care, compliance and Quality Improvement), PBM 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 Management; Clinical Utilization Management; 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 
  • Manage and provide oversight to clinical quality management team
  • Reports regularly to senior leadership on quality improvement initiatives and recommendations

Required Qualifications:

  • Bachelor’s degree required, Advanced degree or Pharmacy degree highly preferred
  • 8+ years of clinical and / or managed care pharmacy experience
  • 8+ years of leadership experience including managing leadership levels
  • 5+ years hands-on experience driving quality improvement initiatives and implementations
  • Strong demonstrated incorporation of metrics into all aspects of daily work
  • 5+ years involvement in clinical pharmacy strategy inclusive of some of following:
    • Prior Authorization  operational functions, clinical development / review /oversight
    • Utilization management criteria development / review
    • Pharmacy & Therapeutics / Drug Information
    • Analytics and reporting
    • Strategic Program development
    • Current industry issues and trends
    • Account Management
  • Demonstrated ability to work collaboratively cross-functionally to deliver results
  • Proficient in Microsoft Word, Excel, PowerPoint, Outlook
  • Strong written and verbal communication  and presentation skills

Preferred Qualifications:

  • Advanced degree or Pharmacy degree
  • PharmD 
  • Current, unrestricted Pharmacist or RN license in the state of California or Illinois
  • MBA or other advanced related degree
  • PBM and / or Health Plan Experience
  • Experience successfully leading project teams
  • Experience working with agencies  such as NCQA, URAC, CMS or similar
  • Understanding of and experience working with Lean / Six Sigma principles and tools
  • Hands on experience with P&T and Formulary Management  
  • Experience preparing and delivering formal presentations

UnitedHealth Group is working to create the health care system of tomorrow.

Already Fortune 6, we are totally focused on innovation and change. We work a little harder. We aim a little higher. We expect more from ourselves and each other. And at the end of the day, we're doing a lot of good.

Through our family of businesses and a lot of inspired individuals, we're building a high-performance health care system that works better for more people in more ways than ever. Now we're looking to reinforce our team with people who are decisive, brilliant - and built for speed.

Come to UnitedHealth Group, and share your ideas and your passion for doing more. We have roles that will fit your skills and knowledge. We have diverse opportunities that will fit your dreams.

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: Senior Director of Clinical Quality, Irvine, California, CA, Schaumburg, IL, Illinois 

Job Details

  • Contest Number737118
  • Job TitleOptumRx Director Clin Quality, Schaumburg IL/Irvine CA
  • Job FamilyPharmacy
  • Business SegmentOptumRx

Job Location Information

  • Schaumburg, IL
    United States
    North America
  • Other LocationsIrvine, CA

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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