Job Description

Caring. Connecting. Growing Together.

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.

Required Qualifications:

• 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

Preferred Qualifications:

• 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

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. 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). The salary for this role will range from $91,700 to $163,700 annually based on full-time employment. We comply with all minimum wage laws as applicable.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

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. OptumCare is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

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