Clinical Pharmacist Utilization Management

UnitedHealth Group • Los Angeles, CA

247d • $89,800 - $176,700 • Remote

About The Position

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. Unique opportunity for a clinical pharmacist to improve patient care and outcomes through completion of utilization management functions for value-based patients in the Optum West region (CA). This is a full-time position with variable hours between 7:00 am to 7:00 pm PST, Monday - Friday (Five 8-hour days). Rotating weekend coverage. 100% telecommuter position.

Requirements

• Doctor of Pharmacy degree (PharmD)
• California Pharmacist license to practice, current and unrestricted
• Willing to pursue licensure in additional states to include AZ, CO, NM, NV, UT, ID, WA & OR
• 3+ years of experience as a Prior Authorization Pharmacist or Clinical Pharmacist, conducting such activities as medication therapy management, clinical rounds, disease state management, etc.
• Proven excellent written and verbal communication skills
• Experience working in a metric-driven environment
• Proven excellent relationship building skills
• Proven solid analytical and PC operation skills

Nice To Haves

• Board certification by the Board of Pharmacy Specialties (BPS)
• Certified Geriatric Pharmacist
• AZ Unrestricted Pharmacist License
• CO Unrestricted Pharmacist License
• NM Unrestricted Pharmacist License
• NV Unrestricted Pharmacist License
• UT Unrestricted Pharmacist License
• WA Unrestricted Pharmacist License
• OR Unrestricted Pharmacist License
• 1+ years of experience in Oncology Setting
• Proven knowledge of Medicare, Medicaid, and commercial payor guidelines
• Demonstrated planning and organizational skills to demonstrate leadership and initiative

Responsibilities

• Completes assigned daily prior authorization case reviews to meet production and performance metrics as determined by the department to maintain compliant timeliness standards
• Review specialty medication prior authorization requests according to established treatment protocols, clinical criteria/guidelines, regulatory requirements and member benefits to ensure consistent and accurate application of clinical criteria & the determination is made within the defined processing times to meet regulatory requirements
• Knowledgeable of current and emerging clinical trends
• Provide internal and external clinical pharmacy subject matter consultation to members, physicians, prescribers, nurses, and pharmacists
• Proactively identify process improvement opportunities and collaborate with other teams and leaders
• 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
• Research and awareness about drug information to maintain drug knowledge and disease state understanding for application to prior authorization reviews
• Follow all policies and procedures, SOPs related to the job
• Performs all other related duties/activities as assigned to meet departmental objectives

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Insurance Carriers and Related Activities
• Education Level: Ph.D. or professional degree