Health care leaders turn to Optum Advisory Services (OAS) for guidance, insights and practical strategies to help assert control over their organization’s future. We are more than just consultants. We are also operators with real-world health care experience, which helps clients hardwire and sustain more meaningful results that would otherwise not be achievable. As integrators across Optum, we deliver unique client-focused strategies and impact. Our proven track record driving success across the entire health care continuum empowers clients to grow, thrive and disrupt.
This role requires a strong foundation of clinical knowledge as well as a deep understanding of Medicare Star Ratings Part D improvement strategies, Medicare compliance and reporting requirements, clinical quality measurement, state and federal regulations, strong written and verbal communication skills, and the ability to advise and lead consulting engagements.
You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
- Serve as a subject matter expert for Clinical Quality Performance Management and Improvement (e.g. Star Ratings, HEDIS®, CAHPS, HOS, etc.)
- Provides leadership, accountability, and responsibility for business development for Quality Advisory Services practice
- Demonstrates understanding of market trends and competition to ensure appropriate consulting offering position and growth
- Lead and oversee business development efforts and strategy including creation, development, and implementation of innovative consulting solutions driven by trends, customer needs and ongoing operational needs within Quality Improvement
- Drives growth, and go-to-market strategy, individual client deal strategies; serves as Clinical Quality subject matter expert
- Identifies internal partnership targets and opportunities that align with Quality Advisory Services growth goals
- Provide support and guidance for hospital quality improvement strategies, publicly reported measures, quality reviews, accreditation requirements and quality program development
- Lead complex consulting engagements
- Develop written proposals and power point decks to support business development and sales efforts
- Assist with the development and execution of strategic plans to support quality improvement interventions
- Support the development, launch and execution of new consulting offerings and technical tools managed by the clinical quality consulting practice group
- Builds relationships with key client partners and executes on product delivery to ensure alignment with client goals to achieve seamless execution and service delivery
- Clinical pharmacist (PharmD)
- 5+ years of experience with Medicare Part C and D operations and compliance policies (Appeals and Grievances, Medication Therapy Management program, etc.)
- 3+ years of experience and accountability for driving Medicare Star Rating improvement for Part D measures (including experience with process improvement, best practices, vendor oversight, and provider and member-centric targeted interventions)
- 3+ years of PBM experience
- Proven track record for Star Rating Part D measure improvement
- Ability to travel up to 80% as required
- Health plan operations experience
- Pharmacy practice experience in any or all of the following settings: hospital pharmacy, retail pharmacy, specialty pharmacy, long term care
- Experience working with PDE files and conducting root cause analysis
- Strong strategic, analytical and problem solving skills
- Excellent negotiation, influencing, collaboration, and listening skills
- Role models an expertise point of view
- Demonstrated ability to work with senior leadership in identifying, accessing, developing, constructing, presenting, negotiating, closing, and managing large deals in healthcare
- Demonstrated ability to effectively message, position and present information for client impact and influence
- Proven ability to operate and effectively navigate in a highly complex, matrix environment
- Ability to successfully negotiate complex internal operating environments with a high level of collaboration
Technology Careers with Optum. Information and technology have amazing power to transform the health care industry and improve people's lives. This is where it's happening. This is where you'll help solve the problems that have never been solved. We're freeing information so it can be used safely and securely wherever it's needed. We're creating the very best ideas that can most easily be put into action to help our clients improve the quality of care and lower costs for millions. This is where the best and the brightest work together to make positive change a reality. This is the place 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: PharmD, Pharmacist, STARS, HEDIS, Medicare, telecommute, travel, PBM, Medicare, Medicaid, telecommute, telecommuting, telecommuter, work from home, WFH, travel, remote