For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together.
Under general supervision of the Director of Clinical Pharmacy, the Clinical Pharmacist is responsible for conducting prior authorization reviews on Part B Specialty/Oncology medications, performing comprehensive and targeted medication management in selected patients to identify, resolve, and prevent medication-related problems as needed for WellMed Managed Care Patients. The Clinical Pharmacist will work with various roles like Nurses, Pharmacy support specialist on day to day basis along with primary care providers and other pertinent health care team members. The Clinical Pharmacist is also focused on achieving optimal use of medications, emphasizing dosing, monitoring, identification of adverse effects, and economic efficiency to achieve optimal patient outcomes.
Primary Responsibilities:
Completes assigned daily cases by processing prior authorization and medical necessity requests for specialty CMS part B medications and meet production, performance metrics as determined by the department in order to comply with CMS Part B turnaround times (TAT)
Review 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 to meet regulatory requirements
Conduct comprehensive medication reviews for select patient population and collaborate with prescribers and other members of the care team to resolve identified medication-related problems
Assist with oversight of medication management activities in employed clinics across the enterprise, in collaboration with the market nurse leadership, to meet state and federal regulations
Provide clinical recommendations, in alignment with evidence based guidelines, pertaining to, but not limited to, gaps in care, high risk medications, compliance and adherence, drug interactions, therapeutic substitution, and generic substitution to both patients and/or providers
Actively maintain knowledge of current and emerging clinical trends to assist with the development of Clinical Practice Guidelines
Active participation in various clinical departmental meetings and forums to improve clinical programs, enhance processes, and share clinical information
Research new prescription drugs or new applications of existing drugs, develops drug use guidelines and communicate findings to providers
Utilizes available prescription/medical data, health plan’s formulary and clinical judgement to perform comprehensive medication reviews, retrospective Drug Utilization Review (DUR) to optimize ongoing medication treatments plans for patients/providers and reducing overall cost burden to the health system
Assist with user acceptance testing for new clinical programs and system enhancements
Ensure and evaluate quality controls and implement opportunities for performance improvement in pharmacy practice specific to specialty pharmacy
Serves as a clinical resource and consultant in all areas of pharmacy and medication management for members, patients, providers, internal departments, and/or external third parties.
Supports overall Enterprise Care &Value department initiatives
Follow all policies and procedures related to job
Performs all other related duties as assigned to meet departmental objectives
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:
Doctor of Pharmacy degree
Current Pharmacist license to practice in the applicable state
2+ years of experience as a Prior Authorization Pharmacist or Clinical Pharmacist, conducting such activities as medication therapy management, clinical rounds, disease state management, etc. Relevant experience includes ANY of the following or a combination thereof:
Retail pharmacy
Pharmacy Benefit Management
Infusion or hospital pharmacy experience
Proven solid analytical and PC operation skills
Willing or ability to travel as necessary (local, 25%)
Preferred Qualifications:
Board certification by the Board of Pharmacy Specialties (BPS)
Certified Geriatric Pharmacist
Certification in Medication Therapy Management (MTM)
Experience with Medicare guidelines
Experience working in a metric-driven environment
Proven ability to obtain additional pharmacist licensure based on business needs
Proven planning and organizational skills to demonstrate leadership and initiative
Proven excellent written and verbal communication skills
Proven excellent relationship building skills
Physical & Mental Requirements:
Ability to lift up to pounds
Ability to push or pull heavy objects using pounds of force
Ability to stand for extended periods of time
Ability to use fine motor skills to operate office equipment and/or machinery
Ability to properly drive and operate a company vehicle
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.