Job details
Job type full-time
Full job description
Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you getLeading edge technology in an industry that`s improving the lives of millionsHere, innovation isn`t about another gadget, it`s about making health care data available wherever and whenever people need it, safely and reliablyThere`s no room for errorJoin us and start doing your life`s best work.(sm)
The quality manager, clinical pharmacy is responsible for engaging our network providers and local pharmacies in discussions related to part d quality measures and programs primarily for our medicare and retirement businessPerformance management is tracked by designated provider metrics, inclusive minimally of 4 star gap closure and improved qualityThe person in this role is expected to work directly with our clinical quality team, providers and pharmacies to build relationships, ensure effective education and share reporting specifically focused on part d measuresThey will proactively identify performance improvement opportunities through data analysis and discussion with subject matter experts; and influence provider behavior to achieve needed results.
If you are located in atlanta, ga, you will have the flexibility to telecommute* as you take on some tough challenges.
Primary responsibilities:
Functioning independently, travel across state of georgia to meet with providers to discuss optum and uhc tools and programs focused on improving the quality of care for medicare advantage members specifically focusing on medication adherence and high risk medications
Strategize with our optum and united healthcare quality team in the development of training and analytical materials for stars and hedis, with a primary focus of medication adherence
Engage and collaborate with pharmacies; including the independent pharmacies across the state, to improve medication adherence of medicare advantage members
Establish positive, long - term, consultative relationships with physicians, medical groups, ipas and acos
Develop comprehensive, provider-specific plans to increase their hedis and part d performance and improve their outcomes
Participate in clinic days to address members with multiple gaps and perform medication reconciliations
Provide ongoing strategic recommendations, training and coaching to provider groups and pharmacies on program implementation and barrier resolution
Act as lead to pull necessary internal resources together in order to provide appropriate, effective provider education, coaching and consultation; training will include stars measures (hedis / cahps / hos / med adherence), optum program administration, and use of plan tools, reports and systems
Provide reporting to health plan leadership on progress of overall performance of pharmacy measures, gap closure, and use of virtual administrative resource
Facilitate / lead monthly or quarterly meetings, as required by plan leader, including report and material preparation
Provide suggestions and feedback to optum and health plan
Provide clinical knowledge to our providers of chronic disease states in particular diabetes, hypertension and hyperlipidemia and changes in pharmacy practice in adult and geriatric patient populations to serve as an authoritative information source on drugs and their utilization in therapy
Deliver high quality evidence-based therapeutic recommendations to providers
Work collaboratively with health plan market leads to make providers aware of plan - sponsored initiatives designed to assist and empower members in closing gaps
75% state-wide travel (bit more travel within new york state)
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, unrestricted pharmacist license in georgia
5+ years of healthcare / pharmacy industry experience
1+ years of direct experience working to close quality measurement gaps and solid working knowledge of clinical standards of care, preventive health, and stars measures
1+ years of medicare market experience
Proficiency with microsoft word, excel, outlook and powerpoint
Ability to travel state-wide up to 75%
Preferred qualifications:
Pharmd degree
1+ years of community pharmacy experience
Stars or hedis experience
Provider facing experience
Experience working with network and provider relations / contracting
Consulting experience
Data analytics experience
Mtm skills with outcomes and mirixa platforms
Solid knowledge of emr
Solid relationship building skills
Unitedhealth group requires all new hires and employees to report their covid-19 vaccination status.
Careers with optumHere`s the ideaWe built an entire organization around one giant objective; make health care work better for everyoneSo 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 serveOptum, 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 potentialFor you, that means working on high performance teams against sophisticated challenges that matterOptum, incredible ideas in one incredible company and a singular opportunity 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 workplaceCandidates are required to pass a drug test before beginning employment.
Job keywords: pharmacist, atlanta, ga, georgia, telecommute, work from home, remote
