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We have modest goals: Improve the lives of others. Change the landscape of health care forever. Leave the world a better place than we found it. Such aspirations tend to attract a certain type of person. Crazy talented. Compassionate. Driven. To these individuals, we offer the global reach, resources and can-do culture of a Fortune 5 company. We provide an environment where you’re empowered to be your best. We encourage you to take risks and in return, offer a world of rewards and benefits for performance. Exceeding your limits is an exceptional start to your life's best work.SM


Just like you, we are driven by a set of fundamental principles that are guiding our way forward. Our values of integrity, compassion, relationships, innovation, and performance serve as a foundation to transform health care. Are you in? Learn more about your future at UnitedHealth Group at careers.unitedhealthgroup.com


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Clinical Preferred Drug List Pharmacist - Nashville, TN

UHG - Nashville, Tennessee

Posted: 10/20/2018

You're looking for something bigger for your career. How about inventing the future of health care? OptumRx is creating an innovative approach to Pharmacy Benefit Management. Here you'll find a professional culture where you can use your talent and our resources to make an impact on a huge scale. Take this opportunity to start doing your life's best work.(sm)
This particular position is for the TennCare (TN Medicaid) request for proposal (RFP).  Employment is contingent upon contract award. 
State of Tennessee
Department of Finance and Administration
Division of Health Care Finance and Administration
Bureau of TennCare
Request for Proposals for Pharmacy Benefit Management
The Clinical Preferred Drug List (PDL) Pharmacist will be dedicated to the Health Care Finance and Administration’s (HCFA) Medicaid Programs, TennCare, CoverRx and CoverKids.
The Clinical Preferred Drug List Pharmacist shall be licensed by the State of Tennessee Board of Pharmacy and whose duties shall include, but are not limited to, all aspects of the TennCare Preferred Drug List and processes and will perform similar duties for the CoverRx and CoverKids Programs. The Clinical PDL Pharmacist shall be readily available to HCFA staff during regular working hours and shall be one hundred percent (100%) dedicated to the HCFA Programs, with approximately ninety five percent (95%) of their time devoted to the TennCare Program and the remaining five percent (5%) split between the CoverRx and CoverKids Programs, on an as needed basis.
Primary Responsibilities:
The Pharmacist shall support the management and coordination of all activities
related to the maintenance of the TennCare PDL. Activities shall include but not be
limited to the following:
  • Present to the TennCare Pharmacy Advisory Committee
  • Conduct clinical reviews of new brand-name drugs and new generic drugs for clinical safety and efficacy, and make recommendations regarding possible inclusion in the TennCare PDL, prior authorization criteria for coverage and appropriate quantity limits where applicable
  • Annually review drugs within chosen therapeutic classes in order to affirm or change the recommendations to the State regarding supplemental rebate strategies
  • Review drug criteria and recommend proposed changes for the TennCare PDL based on new clinical and pharmacoeconomic information, if requested by the State
  • Conduct class reviews of all existing therapeutic categories over a time - frame to be codeveloped
  • with the State
  • Continually and proactively review all products for changes in cost information, including increases and decreases in federal rebates as they affect the TennCare PDL
  • Manage the PDL timeline from preparing for the TennCare Pharmacy Advisory Committee meeting through follow up implementation. This timeline shall be co-developed with the State
  • Implement changes to PDL, Step Therapy or prior authorization requirements which will include modifications to the POS system and all supporting systems and documents
  • Attend, support and facilitate meetings of the TennCare Pharmacy Advisory Committee (PAC) as necessary to maintain the TennCare PDL. Such support shall include the responsibility to develop drug class reviews, prior authorization criteria, quantity limits and step therapy recommendations
  • Present to the TennCare Pharmacy Advisory Committee drug class reviews for new or existing drugs and new indications that might affect their inclusion in the TennCare PDL
  • Monitor compliance by prescribers and pharmacists with the TennCare PDL, report that information to the State monthly, quarterly, and semiannually, and provide suggestions for improving PDL compliance

Required Qualifications:
  • BS degree in Pharmacy or PharmD
  • Current and unrestricted Pharmacist license in the state of Tennessee
  • Minimum 1 year of experience working as a licensed Pharmacist
  • Proficiency in Microsoft Word, Excel and Outlook
  • Formal presentations experience
  • Client facing or clinical account management experience
Preferred Qualifications:
  • PharmD
  • FeeForService Medicaid or  Medicaid Managed Care experience
  • PBM experience
  • Experience with or knowledge of Pharmacy Advisory Committees, DURB (Drug Utilization Review Board) and/or P&T Committees
  • PBM Implementation experience
  • Clinical analytical skills
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)

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: Clinical Pharmacist, Clinical Formulary Pharmacist, Clinical Preferred Drug List Pharmacist, Medicaid Pharmacist


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