Seattle, Washington
Weston, Wisconsin
New York, New York
Tacoma, Washington
Fredericksburg, Virginia
Lake Hallie, Wisconsin
New York, New York
Bellevue, Washington
Tacoma, Washington
New York, New York
Fredericksburg, Virginia
Posted: 30-Aug-24
Location: El Segundo, California
Salary: Open
Categories:
Internal Number: 141903093
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.
We are seeking a highly experienced and strategic Senior Director of Pharmacy Affordability to lead our efforts in managing pharmacy costs and improving access to affordable medications for our members in the West region. This role will have a direct focus on the California market. The ideal candidate will have a deep understanding of vendor management, prior authorization processes, and the overall pharmacy landscape. This role will be critical in driving our pharmacy affordability initiatives, optimizing relationships with internal and external vendors, and ensuring compliance with regulatory requirements.
Primary Responsibilities:
- Develop and execute comprehensive strategies to address pharmacy affordability challenges in the West markets, focusing on innovative solutions and industry best practices
- Strategic Leadership
- Collaborate with cross-functional teams, including clinical, operational, and regulatory departments, to align pharmacy affordability initiatives with overall organizational objectives
- Stay current with emerging trends, upcoming drug releases, treatment guidelines, regulatory changes, and market dynamics to proactively adjust strategies and ensure competitive positioning
- Develop and maintain pharmacy programs: drug utilization review assessments, prior authorization, vendor collaboration and utilization, and specialty programs
- Write and collaborate on member/provider collateral materials for pharmacy programs
- Vendor Management
- Lead and oversee all aspects of pharmacy vendor management, including contract design, performance evaluation, and ongoing relationship management including but not limited to payors, pharmacy vendors and rebate organizations
- Develop and implement strategies to optimize vendor performance and ensure alignment with organizational goals for cost containment and affordability
- Collaborate with vendors to identify cost-saving opportunities, enhance service delivery, and improve member satisfaction
- Maintain and build client relationships and serve as outward facing primary point of contact for overall and day-to-day service delivery (e.g. claims issues, prior auth/appeal resolution, and program implementation/review) for large/complex accounts
- Prepare and present reports on utilization of current program offerings and recommendations for strategies to manage utilization and ensure programs fit the population served
- Represent client(s) internally and coordinate with other functions to implement client programs, complete system updates and projects, and address ongoing pharmacy service needs
- Part B Prior Authorization (PA)
- Oversee the California Part B PA team completing prep, review and approve/deny requests for prescription prior authorization and/or appeal
- Work on program implementation teams and contribute to business process design and systems set up, trouble shooting and ongoing updates
- Review programs for compliance to state, federal and CMS regulations and recommend remediation. Monitor impending legislation for potential impact to current and future programs
- Analyze data and prepare management summaries related to work stream results, performance mgmt. results, audit results, CMS reporting, and client reporting
- Data Analysis and Reporting:
- Utilize data analytics to assess the impact of pharmacy affordability initiatives, identifying trends and opportunities for further improvement
- Provide regular reports and presentations to senior leadership, detailing the effectiveness of vendor management and prior authorization strategies
- Leadership Responsibilities:
- Provide supervision and guidance in the professional growth and development of the assigned staff
- Resolve business problems that affect multiple functions or disciplines
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:
- PharmD or BS in pharmacy
- Requires current Pharmacist license without restrictions
- 4+ years of experience with coaching, mentoring and training
- 3+ years of experience managing a team
- 3+ years of client facing experience
- Experience with Part B Pharmacy Utilization Management and Prior Authorization
- Experience with CMS, Medicare Advantage plans or managed care
- High level skill in Microsoft Word, Outlook, PowerPoint, Smartsheet and Excel
- Proven excellent communication, negotiation, and leadership skills, with the ability to influence cross-functional teams and drive organizational change
- Proven solid financial acumen of pharmacy products, services and affordability initiatives
- Proven solid analytical skills with the ability to interpret complex data and develop actionable strategies
Preferred Qualifications:
- Advanced degree (MBA, MHA, MS, etc.
- Completion of a PGY1/PGY2 pharmacy residency
- BPS board certification (BCPS, BCACP, BCGP) or other added qualifications
- Familiarity with health plan operations, including formulary management and cost-containment strategies
California Residents Only: The salary range for this role is $122,100 to $234,700 annually. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.
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: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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.
OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
