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Providing outstanding service to our Medicaid Health plans takes a solid mix of business skills, technical proficiency, and industry knowledge. We have a strong team of pharmacists and pharmacy service specialists and we are looking for a talented individual to join us as we grow our business. In this position, our new team member will have the opportunity to develop an expertise in the Medicaid, DSNP, and Exchange business. The Plan Pharmacy Director serves as the primary point of contact to the Pharmacy Management program for the Community Plan health plan management team related to execution of the pharmacy benefit program. In this role you will be the primary point of contact to the NY Health Plan for all pharmacy issues and will be accountable for developing ongoing relationship with the plan and the Pharmacy Director at the state Medicaid agency.
If you are located in the state of NY, NJ and PA, you will have the flexibility to telecommute* as you take on some tough challenges. Commutable distance from Manhattan, NY is highly preferred.
- Build and maintain client relationships and serve as the primary point of contact for overall and day-to-day service with local UHC plan
- Build strong working relationships with Plan CEO, COO, CFO, and Medical Director
- Assist plan on all pharmacy related activities including clinical program development and improving member satisfaction
- Responsible for understanding and assuring compliance with the state contract and the rules governing pharmacy (formulary / PDL, UM, member communications, etc.)
- Accountable for creation and maintenance of state specific polices
- Service as the SME SPOC for benefit and coding requirements and responsible for communication to appropriate internal stakeholders for implementation
- Develop a strong working knowledge of health plan operations (compliance, finance, encounters, claims adjudications, networks, clinical, case management, HEDIS measures, etc.)
- Collaborate with internal partners to complete projects and to address on-going pharmacy service needs of the plan
- Analyzing, reviewing, forecasting, trending, and presenting information for operational and business planning
- Communicates pharmacy program changes with the assigned health plans key departments
- Support Plan short and long term operational / strategic business activities by maintaining operational information
- Attend State Medicaid meetings and build relationship with the State pharmacy team (Post Covid)
- Attend state pharmacy and health plan association meeting and build relationships (Post Covid)
- Responsible for the timely submission of accurate pharmacy reports and deliverables
- Support the assigned health plans Grievances Department in the processing of grievances, appeals, fair hearings, etc., as defined by the health plans process to ensure a timely decision by the plan Medical Director
- Support assigned health plans Health Services, Case Management and Behavioral Health areas regarding targeted members with specific pharmacy concerns
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.
- Current, unrestricted Pharmacist license. Having a NY license is not required
- 3+ years of Clinical Pharmacy, Sales, or Account Management experience or combination thereof
- Proficiency in Microsoft Office Suite, including Word, Excel, and PowerPoint
- If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or similar UnitedHealth Group-approved symptom screener. When in a UnitedHealth Group building, employees are required to wear a mask in common areas. In addition, employees must comply with any state and local masking orders
- 3+ years of experience in Managed Care Pharmacy either in a Health Plan or PBM
- 1+ years of direct experience with Medicaid / Medicare plans
- Experience with Pharmacy Utilization Review
- Understanding pharmacy trend
- Understanding of health plan - PBM contracts and pricing
- Understanding and interpretation of state contract language
- Experience building and maintain client relationships and networking
- Experience developing and implement clinical program to reduce trend or improve member experience
- Ability to assist with focusing activities toward a strategic direction
- Ability to develop tactical plans, drive performance and achieve targets
- Problem solving skills; the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action
- Excellent verbal and written communication skills; 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
Careers at UnitedHealthcare Medicare & Retirement. The Boomer generation is the fastest growing market segment in health care. And we are the largest business in the nation dedicated to serving their unique health and well-being needs. Up for the challenge of a lifetime? Join a team of the best and the brightest to find bold new ways to proactively improve the health and quality of life of these 9 million customers. You'll find a wealth of dynamic opportunities to grow and develop as we work together to heal and strengthen our health care system. Ready? It's time to do your life's best work.(sm)
*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer 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.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
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