Associate Director Clinical Pharmacy, PharmD - Irvine, CA

As one of the largest pharmacy benefits managers in the United States, UnitedHealth Group provides a professional culture where you're empowered and encouraged to exceed the expectations of our members, with better schedules than retail and more reach than any hospital. Join us and start doing your life's best work.(sm)

The Director of Pharmacy, Clinical Services is responsible for the strategic planning, development and implementation of pharmacy initiatives related to pharmacoeconomics, utilization management, and Pay for Performance, with a focus on improved health outcomes.

Develops and implements strategies that positively impact physician's pharmaceutical utilization, performs drug utilization reviews and evaluations, reviews pharmacy related claims issues, evaluates pharmaceutical services and products, and participates on committees.

S/he works in collaboration with the CMO, Medical Directors, and Clinical Directors to ensure the successful achievement of Monarch HealthCare's vision by participating in the development and implementation of clinical strategic initiatives to achieve the department's goals and objectives in compliance with established medical policies and procedures.

Primary Responsibilities:

• Assumes a leadership role in the planning, development and implementation of pharmacy programs and processes that result in increased generic utilization, decreased hospital and emergency room utilization, increased outpatient infusion therapy utilization, and increased Pay for Performance revenue


• Plans, develops and implements physician education programs related to new treatment modalities for various disease states, HEDIS/P4P, CMS  Star Ratings, Medicare Part B and & D drugs, and  pharmacy utilization management best practices


• Assists Medical Directors in executing and implementing intervention strategies at various physician practices to manage pharmacy utilization related to pharmacy risk pools and generic incentive programs


• Participates in Joint Operating and Medical Management Committees and designs and implements cost/utilization and trend analysis reports for pharmacy utilization provided by health plans, including recommendations for physicians


• Participates in managing daily authorizations for appropriateness of various injectables, IV solutions, and chemotherapy, including the development of policies and procedures for appropriate optimal cost savings treatment plans


• Identifies potential vendors and assists the Network Management Department with contract negotiations


• 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


• Collaborates with High Risk Touch Teams to ensure effective medication reconciliation and patient education for high risk patient in order to decrease readmissions and avoidable emergency room visits


• Participates in the interdisciplinary case management meetings


• Participates in the Quality Improvement Committee, Utilization Management Committee, and other meetings such as Credentialing and Peer Review Committee and Readmission Rounds as requested


• Actively participates in the development and implementation of Disease Management Programs


• 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 CMO, Medical Directors and Clinical Directors in all strategic planning, including establishing annual departmental goals and objectives


• Under the direction of the CMO and in collaboration with the Medical Directors and Clinical Affairs Directors, develops and coordinates the implementation of Pharmacy medical management processes, policies and procedures to assure that medically necessary services are delivered in an optimally cost and quality efficient  manner


• In partnership with Medical Directors and Clinical Affairs Directors, identifies areas of over or under pharmacy utilization, often through collaboration with finance and decision support departments.  In conjunction with the CMO  and the Clinical Services Medical Management Team develops and implements corrective action plans resulting in required process changes  and outcomes when aberrant trends are identified


• Promotes a culture of open, clear communication and collaboration interdepartmentally and intradepartmentally and with external customers and organizations


• Consistently supports compliance by maintaining the privacy and  confidentiality of information, protecting the assets of the organization,  acting with ethics and integrity, reporting non compliance, and adhering to  applicable federal, state and local laws and regulations, accreditation and  license requirements (if applicable), and current MHC policies and  procedures


• Regular and consistent attendance


• Serves as liaison and channel of communication for Pharmacy related issues between the CMO and committees, external customers and organizations, and the medical and administrative staff


• Performs other related duties as required

Required Qualifications:

• Doctor of Pharmacy degree


• Active Registered Pharmacist license for California


• 5+ years of medical management experience with IPAs, medical groups or HMOs


• 3+ years with an IPA or medical group

What's the first thing that happens when one of the most successful physician groups in Orange County comes together with a global leader in health care? Opportunity. With Monarch HealthCare joining Optum and the UnitedHealth Group family of companies, people like you will find increasing levels of challenge, impact and professional success. With a vibrant network of hospitals and urgent care centers, we're changing health care for the better by improving access to affordable, high quality care, and working together to improve the patient experience. That takes passion, commitment, intense focus and the ability to contribute effectively in a highly collaborative team environment. Are you with us? Learn more about this exciting opportunity to do your life's best work.SM