Clinical Pharmacist - Remote in CST or EST

UnitedHealth Group•Pittsburgh, PA

3h•Remote

About The Position

The Clinical Pharmacist will support the Clinical Pharmacy team by developing and maintaining drug policies for the pharmacy and medical benefit, supporting United’s Medicaid line of business. This role will partner with peers supporting formulary and trend management, clinical pharmacy operations, drug utilization review programs, and state partners to develop and implement clinical programs and formularies that support plan objectives and organizational growth goals. The ideal candidate will be able to provide subject matter expertise across both the pharmacy and medical drug benefit, have a strong understanding of process development and implementation and possess a strong analytical skillset with the ability to turn large datasets into end user formats to be used to measure performance and/or support clinical decision making. You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.

Requirements

Registered Pharmacist with license in good standing within a US State or Territory
3+ years of clinical pharmacy experience or completion of a managed care pharmacy residency
Experience with writing/developing utilization management criteria for medications available on the pharmacy benefit
Experience with presenting clinical content and recommendations to various audiences
Solid proficiency in Sharepoint, MS Office Suite (including Excel)
Solid organizational skills with the ability to balance multiple tasks and both accept direction, and self-manage daily activities
Skilled communicator with an ability to adapt written and verbal communications to needs of audience
Ability to work both independently and within a matrixed team environment to deliver objectives within an established timeline
Demonstrated curiosity and willingness to adopt new tools and approaches, including AI-enabled analytics or automation such as CoPilot, to improve efficiency and effectiveness

Nice To Haves

Completion of a managed care pharmacy residency
Attained Board of Pharmacy Specialties (BPS) certification or other equivalent accredited pharmacy board certification
Experience with writing/developing utilization management criteria for physician administered medications
Experience with Microsoft Access and advanced analytical tools such as Tableau, SQL, and/or SAS
Proven analytical skills with an ability to sift through data and identify solutions to solve problems
Demonstrated ability to build internal and external relationships with key stakeholders

Responsibilities

Support the strategy and development of formularies for the Medicaid business to provide clinically sound and affordable care for members, while meeting all government required regulations
Build and maintain utilization management programs for the Medicaid business. These programs include but are not limited to prior authorization, quantity limits, and step therapy edits
Discuss proposed policies with key stakeholders
Measure and report the value of utilization management programs for the Medicaid business
Serve as a clinical liaison to our National Pharmacy and Therapeutics Committee, including presenting utilization management programs for approval
Develop strong partnerships with cross functional team members, including from our PBM, to support the Medicaid business
Help support appeals team on member and provider appeals of coverage decisions
Problem solve and recommend approaches based on review of clinical literature