Clinical Pharmacist - West Region

UnitedHealth Group•El Segundo, CA

5d•$91,700 - $163,700•Remote

About The Position

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. Hours/Location: Must reside in Pacific or Mountain Time Zone. Variable hours to work 8-hours within the hours of 8:30 AM - 6:00 PM Pacific Standard Time Monday - Saturday based on business needs. You’ll enjoy the flexibility to work remotely from anywhere within Pacific or Mountain Standard Time Zones in the U.S. as you take on some tough challenges. Primary Responsibilities: Medical/Clinical: Conducts provider peer‑to‑peer clinical consultations to support medication-related changes, including dose, frequency, route of administration, and therapeutic substitutions. The role involves reviewing clinical documentation, prescription claims, and prior authorization data to assess the appropriateness of formulary and benefit-aligned alternatives and to provide evidence-based recommendations to prescribers. Apply clinical judgment to balance quality of care, medication access, and cost containment while ensuring accurate documentation and compliance with regulatory and organizational standards. Maintain clinical standards by staying current on drug information, emerging clinical trends, and best practices. Collaborate with providers and market leaders, developing market presentations, and offering pharmacy subject matter expertise Strategy and Execution: Track drug usage, pricing, formularies, and utilization management edits to guide affordability and quality strategy for injectable and infusion drugs. Execute value-based care initiatives and coordinate patient drug therapy at optimal sites of service and benefit. The role actively engages with patients and providers telephonically, by facsimile, and other electronic means to provide internal and external clinical pharmacy subject matter consultation Cross-Functional Team Collaboration: Engage collaboratively with cross-functional teams to design and execute strategic initiatives that advance care delivery and network management, ensuring compliance and upholding clinical excellence. These teams represent diverse functional areas such as pharmacy care management, utilization management, payment integrity, claims operations, health care economics, finance, and contracting. Proactively identify process improvement opportunities and collaborate with other teams and leaders Process Improvement/Compliance: Ensure and evaluate quality controls and implement opportunities for performance improvement in pharmacy practice. Follow all policies and procedures, SOPs related to the job Monitor and Assess: Assist with user acceptance testing for new clinical programs and system enhancements. Measure interventions and review outcomes to set benchmarks and share performance with key decision makers and leaders of healthcare team. Adjust strategic initiatives to meet program targets and goals Performs all other related duties/activities as assigned to meet departmental objectives These efforts collectively promote clinical efficacy, cost-efficiency, and improved patient outcomes. Broad-based and comprehensive knowledge is critical to success in this role. You'll need to be comfortable making recommendations on behalf of a highly diverse patient population. In addition, you'll need to be well-versed in medical and pharmacy claims data. 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.

Requirements

Graduate of an ACPE-accredited PharmD program
Current, clear, and unrestricted pharmacist licensure in California
Successful completion of a PGY1 pharmacy residency program and at least one year of pharmacy experience, OR a minimum of three years of pharmacy experience
3+ years of independently communicating specific medication recommendations, therapies for cost-effective care and general drug information to health care providers and patients in a virtual and/or telehealth setting
2+ years of working collaboratively in multidisciplinary teams and inside a matrixed organization
1+ years of working in a metric-driven environment
Experience in leading clinical operations, data analysis, report development, or program development within the healthcare field
Comprehensive knowledge of clinical therapeutics for specialty drugs, including infusions and injectables, and proficiency in literature search and evidence-based medicine
Familiarity with value-based care, including shared savings/risk models
Intermediate or higher level of proficiency in MS suite, including Excel (pivot tables, xlookups, index match, countifs), Power BI, Outlook, and Teams
Intermediate or higher level of proficiency in Epic EHR in the ambulatory care setting
Proven robust analytical and mathematical skills, including the ability to reconcile medical and pharmacy claims to identify trends in drug costs

Nice To Haves

Successful completion of a PGY2 pharmacy residency program or fellowship
Active board certification through Board of Pharmacy Specialties (BPS) [eg, BCPS, BCACP, BCGP, BCOP]
Additional current, clear, and unrestricted pharmacist licensure in Arizona, Colorado, Idaho, Nevada, New Mexico, Oregon, Utah, and/or Washington
2+ years of managed care/health plan/PBM experience
2+ years of experience in Medicare Advantage, Commercial and/or Medicaid programs
Experience in specialty infusion care delivery, inclusive of home infusion operations
Proven excellent program and project management skills demonstrated by a significant record of performance (ie, meeting or exceeding operational goals) in health care quality and cost management

Responsibilities

Conducts provider peer‑to‑peer clinical consultations to support medication-related changes, including dose, frequency, route of administration, and therapeutic substitutions
Reviews clinical documentation, prescription claims, and prior authorization data to assess the appropriateness of formulary and benefit-aligned alternatives and to provide evidence-based recommendations to prescribers
Applies clinical judgment to balance quality of care, medication access, and cost containment while ensuring accurate documentation and compliance with regulatory and organizational standards
Maintains clinical standards by staying current on drug information, emerging clinical trends, and best practices
Collaborates with providers and market leaders, developing market presentations, and offering pharmacy subject matter expertise
Tracks drug usage, pricing, formularies, and utilization management edits to guide affordability and quality strategy for injectable and infusion drugs
Executes value-based care initiatives and coordinate patient drug therapy at optimal sites of service and benefit
Actively engages with patients and providers telephonically, by facsimile, and other electronic means to provide internal and external clinical pharmacy subject matter consultation
Engages collaboratively with cross-functional teams to design and execute strategic initiatives that advance care delivery and network management, ensuring compliance and upholding clinical excellence
Ensures and evaluate quality controls and implement opportunities for performance improvement in pharmacy practice
Follows all policies and procedures, SOPs related to the job
Assists with user acceptance testing for new clinical programs and system enhancements
Measures interventions and review outcomes to set benchmarks and share performance with key decision makers and leaders of healthcare team
Adjusts strategic initiatives to meet program targets and goals
Performs all other related duties/activities as assigned to meet departmental objectives

Benefits

In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).
No matter where or when you begin a career with us, you’ll find a far-reaching choice of benefits and incentives.

Stand Out From the Crowd

Upload your resume and get instant feedback on how well it matches this job.

Upload and Match Resume