Fort Wayne, Indiana
Novi, Michigan
Saginaw, Michigan, Michigan
Minneapolis, Minnesota
Pineville, Louisiana
Posted: 28-Dec-24
Location: Southfield, Michigan
Categories:
Internal Number: 145453661
At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.
Providing outstanding service to our Medicaid Health plans takes a solid mix of business skills, technical proficiency, and industry knowledge. We have a strong team of pharmacists and pharmacy service specialists, and we are looking for a talented individual to join us as we grow our business. In this position, our new team member will have the opportunity to develop an expertise in the Medicaid, DSNP. The Plan Pharmacy Director serves as the primary point of contact and is accountable to the Michigan Community Plan leadership and the state Medicaid agency related to execution of the pharmacy benefit program and strategy.
Position is Plan Pharmacy Director, a dedicated resource and key staff of the Michigan health plan. Role includes PDL implementation and maintenance activities, pharmacy reporting, management of state pharmacy relationship, attendance at pharmacy related meetings with internal and external stakeholders, key contact for pharmacy to internal and external stakeholders, developing and executing pharmacy strategy, ensuring pharmacy benefit compliance, communicating pharmacy trends and value proposition, developing and executing on affordability initiatives, supporting clinical and quality initiatives.
If you are located in Michigan, you will have the flexibility to work remotely* as you take on some tough challenges. Position also requires travel in the state of Michigan about 10% of the time.
Primary Responsibilities:
- Ensure compliance with all requirements specified by the State and federal statutes and regulations, including the Michigan Board of Pharmacy
- Utilizes broad understanding of managed care and PBM knowledge to develop, execute, and drive strategic plans and goals
- Analyzes and reviews forecasting and trend information for operational and business planning
- Provide strategic direction, operations oversight, and financial impact analysis as it pertains to pharmacy program priorities for the health plan
- Builds and maintain solid relationships with internal and external partners and serve as the primary point of contact for Pharmacy and Pharmacy Services
- Assist plan on all pharmacy related activities including clinical program development and improving member satisfaction.
- Accountable for creation and maintenance of state specific polices
- Service as the SME SPOC for benefit and coding requirements and responsible for communication to appropriate internal stakeholders for implementation
- Have a solid working knowledge of health plan operations (compliance, finance, encounters, claims adjudications, networks, clinical, case management, HEDIS measures, etc.)
- Collaborate with internal partners to complete projects and to address on-going pharmacy service needs of the plan.
- Conduct and manage outcomes of various studies that include analyzing, reviewing, forecasting, trending, and presenting information for operational and business planning
- Communicates pharmacy program changes with the assigned health plans key departments
- Engages state Medicaid, pharmacy and health plan association and other external stakeholders to build and maintain relationships
- Ensure timely submission of accurate pharmacy reports and deliverables as required by the state Medicaid agency and the health plan
- Support the health plan departments to ensure resolution of pharmacy related issues
You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:
- Current, unrestricted Michigan Pharmacist license
- 3+ years of Clinical Pharmacy, Sales, or Account Management experience or combination thereof
- 3+ years of experience in Managed Care Pharmacy either in a Health Plan or PBM
- 1+ years of direct experience with Medicaid/Medicare plans
- Intermediate to advance proficiency in Microsoft Office Suite, including Word, Excel and PowerPoint
- Reside in the State of Michigan
- Ability to travel locally 10% of the time
Preferred Qualifications:
- PharmD
*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.
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.
