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UnitedHealth Group Clinical Programs Pharmacist - Ontario, CA in Ontario, California

North American Medical Management, California, Inc. (NAMM) develops and manages clinician networks, offering a full range of services to assist physicians and other clinicians in their managed care and business operations. For over 17 years, NAMM has been an innovator in health care with a track record for quality, financial stability, extraordinary services and superior electronic capabilities. Prime Care Medical Network is a key affiliate.

The Clinical Programs Pharmacist is responsible for assisting and supporting the Clinical Pharmacy team in strategic planning, development of pharmacy initiatives related to pharmacoeconomics, medication reconciliation, pharmacist based clinics, and regulatory and health plan oversight, with a focus on improved health outcomes.

The Clinical Programs Pharmacist is responsible for both direct and indirect patient care, drug therapy monitoring, formulary management prior authorization review, staff education, patient consultation, cost containment and serves as Pharmacy’s liaison with physicians and other health practitioners. The Clinical Pharmacist interfaces with physicians and other members of the health care team and serves as an authoritative information source on drugs and their utilization in therapy.

The chosen candidate will work in collaboration with the Clinical Pharmacy, Utilization Management, Healthcare Economic, and High Risk Case Management teams to ensure the successful achievement of NAMM’s vision.

You’ll enjoy the flexibility to telecommute* from Ontario, CA as you take on some tough challenges.

Primary Responsibilities:

  • Reviews requests for select injectable medications with consideration to clinical guidelines and patient specific factors and interfaces with physicians, nurses, physician offices, and pharmacies accordingly

  • Assists with implementation of clinical pharmacy and utilization management programs to contain cost and increase safety and efficacy as they relate to medication management

  • Works closely with analysts and the Health Care Economic team to measure the impact of clinical pharmacy and utilization management programs

  • Provides regulatory and health plan oversight by reviewing provider disputes and cap deduct reports

  • Assists in the planning, and implementing of physician and staff education programs related to new treatment modalities for various disease states, Medicare Part B and & D drugs, and pharmacy utilization management best practices

  • Available and acts as a clinical/pharmacy resource for Clinical Service’s case managers including identifying high volume/high cost pharmacy utilizing members and assisting with the development of case management planning

  • Actively involved with various vendors and works closely with the Contracting Team on pharmacy related contracts

  • Attends weekly patient rounds and collaborates with High Risk Case Management Teams to ensure effective medication reconciliation and patient education for high risk patient in order to decrease readmissions and avoidable emergency room visits

  • Maintains a working knowledge of changes in pharmacy practice, including pharmacy laws and drugs, and applies this knowledge in the performance of daily activities

  • Identifies opportunities for improvement and provides additional orientation, training and skill development to internal staff and external customers on an ongoing basis

  • Participates in the Clinical Services Medical Management Team and collaborates with the Pharmacy Department in all strategic planning

  • Counsels patients and their care givers on safe and appropriate use of drugs

  • Performs medication reconciliation calls with patients to provide optimum drug therapy while reducing the potential for drug duplication or adverse drug events

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:

  • Current and unrestricted pharmacist licensure in the state of Califorina

  • 3+ years of experience working as a clinical pharmacist

  • Experience conducting research and analysis

  • Experience working with patients face to face

  • Customer Service experience

  • 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 a similar UnitedHealth Group-approved symptom screener. Employees must comply with any state and local masking orders. In addition, when in a UnitedHealth Group building, employees are expected to wear a mask in areas where physical distancing cannot be attained

Preferred Qualifications:

  • PBM experience

  • Pharm D

  • Pharmacy residency experience

  • Experience with project development/building

  • Knowledge of and terminology experience with Pharmacy benefits

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)

North American Medical Management, California, Inc. (NAMM California) partnered with OptumHealth in 2012. NAMM California and OptumHealth share a common goal of bringing patients, physicians, hospitals and payers closer together in the mission to increase the quality, efficiency and affordability of care. NAMM California is a part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system. NAMM California develops and manages provider networks, offering a full range of services to assist physicians and other providers in supporting patient care coordination and their managed care business operations. For over 18 years, NAMM California has been an innovator in health care with a track record for quality, financial stability, extraordinary services and integrated medical management programs. NAMM California is well positioned to continually invest in its infrastructure and systems for the benefit of its provider clients and to accommodate the impending changes that will come forth from healthcare reform.

The NAMM California provider clients represent a network of almost 600 primary care physicians and over 3,000 specialists and work with the premier hospitals in their respective markets.

*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.

Job Keywords: Pharmacist, NAMM, CA, California, Optum, clinical, utilization management, healthcare, medical, pharmacy, Ontario, CA, California

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