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UM, Director of Pharmacy - San Antonio *$6K SIGN-ON BONUS*

UnitedHealth Group

San Antonio, TX
Job Code:
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Job Details

UM, Director of Pharmacy - San Antonio *$6K SIGN-ON BONUS*(Job Number:687271)

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) 

Under the direction of the VP of Pharmacy Program, the UM Director of Clinical Pharmacy will be responsible for the coordination of all UM pharmacy programs with the Medical Management leaders to ensure appropriate medication review and cost effectiveness. This position will collaborate with the Regional Medical Directors, market and care management leaders to improve QI metrics related to medication management and serve as a co-chair for the Medical Management P&T Committee.


Primary Responsibilities:

  • Functions in a lead role planning and implementing UM pharmacy programs and initiatives
  • Reviews specialty medication prior authorization requests (i.e. biopharmaceuticals) according to established treatment protocols, clinical criteria and member benefits and make determinations within the defined turnaround times and meet regulatory requirements
  • Manage and coach the direct reporting individuals in the Pharmacy Department
  • Manages and updates the specialty/Part B injectable drug review policies and procedures to ensure compliance with CMS requirements
  • Manages the specialty pharmacy sourcing for injectable drugs
  • Serve as a co-chair on the Medical management P&T Committee
  • Develops and implements clinical cost of care strategies for auditing of B vs. D claims in coordination and collaboration with UM, claims and configuration department
  • Develops and implements clinical cost of care strategies and quality initiatives as needed to help reduce pharmacy cost and utilization
  • Read, analyze, and interpret common scientific and technical journals, financial reports, and legal documents
  • Respond to inquiries or complaints from customers or members of the business community and effectively present 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
  • Interface with key external constituents as needed (clinics, physician group, hospitals) regarding pharmacy program, preferred drug list and pharmacy processes
  • Provide routine, timely and accurate communication to health plan management regarding pharmacy programs, cost issues, utilization issues, budget performance, etc.
  • Support health plan initiatives that include pharmacy components
  • Serve as a clinical resource and consultant in all areas of pharmacy and medication management
  • Supports medical management and clinical/quality initiatives across the organization
  • 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
  • Special projects and other related duties as assigned

Job Pharmacy Clinical Programs
Primary Location US-TX-San Antonio
Other Location 
Organization WellMed Medical Mgmt, Inc
Schedule Full-time
Number of Openings 1
Apply on the Company Site

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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