The Clinical Pharmacist Quality Manager 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 business. Performance management is tracked by designated provider metrics, inclusive minimally of 4 STAR gap closure and improved quality. The 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 measures. They will proactively identify performance improvement opportunities through data analysis and discussion with subject matter experts; and influence provider behavior to achieve needed results.
Must reside local for required travel.
Position requires 75% travel throughout Tennessee and SW Virginia. Majority of the travel will be throughout Eastern Tennessee.
- Functioning independently, travel across assigned territory 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
- Role includes up to 75% local travel
BS in Pharmacy or Pharm D
Current, unrestricted Pharmacist license in the state of Tennessee
Current, unrestricted Pharmacist license in the state of Virginia, or the ability to obtain one within 6 months of employment
Knowledge base of clinical standards of care, preventive health, and Stars measures
1+ year of Stars experience
- 1+ year of community pharmacy experience
- 1+ year of Medicare market experience
Strong MTM skills with Outcomes and Mirixa platforms
Experience in managed care working with network and provider relations / contracting
Population Health management experience regarding medication adherence programs
Strong knowledge of electronic medical record systems
Microsoft Office specialist with exceptional analytical and data representation expertise
Advanced Excel, Outlook, and PowerPoint skills
- Strong communication and presentation skills
- Strong relationship building skills with clinical and non - clinical personnel
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)
*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, RPh, Stars, Performance Manager, Quality Advocate, Quality, Project Management, Consulting, Providers, Member Groups, Contracts, Health Plan, Quality Improvement, Field Based, telecommute, Knoxville, TN, Tennessee