UnitedHealth Group-posted 3 months ago
$110,200 - $188,800/Yr
Full-time • Mid Level
Overland Park, KS
5,001-10,000 employees

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. The Plan Pharmacy Director serves as the primary point of contact and is accountable to the Kansas Community Plan leadership and the state Medicaid agency related to execution of the pharmacy benefit program and strategy. The Plan Pharmacy Director is a dedicated resource and key staff of the Kansas Health Plan; that is accountable for setting the strategic direction, operational execution, oversight and financial impact analysis of pharmacy program priorities for the health plan. The role includes preferred drug list (PDL) implementation and maintenance activities, pharmacy reporting, management of state pharmacy relationship, active engagement at pharmacy related meetings with internal and external stakeholders as the pharmacy subject matter expert, 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. This position will be part of the UnitedHealthcare Community and State Pharmacy team, reporting directly into the Regional Director Pharmacy Services.

  • Executes the pharmacy benefit and compliance with the state contract, state policies, and state/federal statutes and regulations governing pharmacy
  • Represents plan at Kansas Medicaid Drug Utilization Board meetings
  • Oversees preferred drug list (PDL) implementation and maintenance activities
  • Utilizes broad understanding of managed care and PBM knowledge to develop, execute, and drive strategic plans and goals
  • Ensures timely submission of accurate pharmacy reports and deliverables as required by the state Medicaid agency and the health plan
  • Analyzes forecasting and trend information for operational and business planning
  • Builds and maintain strong relationships with internal and external partners and serve as the primary point of contact for Pharmacy and Pharmacy Services
  • Assists plan on all pharmacy related activities including clinical program development and improving member satisfaction
  • Accountable for creation and maintenance of state specific policies
  • Serves as the SME SPOC for formulary, prior authorization and benefit coding requirements and execution and responsible for communication with stakeholders for implementation
  • Demonstrates a strong working knowledge of health plan operations (compliance, finance, encounters, claims adjudications, networks, clinical, case management, HEDIS measures, etc.)
  • Collaborates with internal partners to complete projects and to address on-going pharmacy service needs of the plan
  • Communicates pharmacy program changes
  • Engages state Medicaid, pharmacy and health plan association meetings and build relationships as the health plan pharmacy subject matter expert
  • Supports the health plan departments to ensure resolution of pharmacy related issues
  • Provides strategic direction, operational oversight, and financial impact analysis as it pertains to pharmacy program priorities for the health plan.
  • Trains and educates on relevant policies and procedures related to the pharmacy benefit
  • Other duties as assigned
  • B.S.Pharm or Pharm.D.
  • Current, unrestricted Kansas 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+ year of direct experience with Medicaid/Medicare plans
  • Experience in engaging, and presenting, to groups including senior level management
  • Intermediate to advance proficiency in Microsoft Office Suite, including Word, Excel and PowerPoint
  • Resides in Kansas
  • Excellent verbal and written communication skills
  • Proven ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others
  • Highly motivated and self-directed
  • Proven excellent time management, organizational, and prioritization skills and ability to balance multiple priorities
  • Proven prior experience working with pharmacy data and experience with Pharmacy Utilization Review and understanding pharmacy trend
  • Comprehensive benefits package
  • Incentive and recognition programs
  • Equity stock purchase
  • 401k contribution
© 2024 Teal Labs, Inc
Privacy PolicyTerms of Service