Clinical Pharmacist, Ontario, CA

North American Medical Management, California, Inc. (NAMM California) partnered with Optum in 2012. NAMM California and Optum share a common goal of bringing patients, physicians, hospitals and payers closer together in the mission to increase the quality, efficiency and affordability of care. NAMM California is a part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system. NAMM California develops and manages provider networks, offering a full range of services to assist physicians and other providers in supporting patient care coordination and their managed care business operations. For over 18 years, NAMM California has been an innovator in health care with a track record for quality, financial stability, extraordinary services and integrated medical management programs. NAMM California is well positioned to continually invest in its infrastructure and systems for the benefit of its provider clients and to accommodate the impending changes that will come forth from healthcare reform.
 
The NAMM California provider clients represent a network of almost 600 primary care physicians and over 3,000 specialists and work with the premier hospitals in their respective markets.
 
As a part of our continued growth, we are searching for a new Clinical Pharmacist to join our team.
 
The Clinical Pharmacist is responsible for assisting and supporting the Clinical Pharmacy team in strategic planning, development of pharmacy initiatives related to pharmacoeconomics, utilization management, medication reconciliation, pharmacist based clinics, and regulatory and health plan oversight, with a focus on improved health outcomes.
Primary Responsibilities:

Reviews requests for select injectable medications with consideration to clinical guidelines and patient specific factors and interfaces with physicians, nurses, physician offices, and pharmacies accordingly
Develops and implements clinical pharmacy and utilization management programs to contain cost and increase safety and efficacy as they relate to medication management
Works closely with analysts and the Health Care Economic team to measure the impact of clinical pharmacy and utilization management programs
Provides regulatory and health plan oversight by reviewing provider disputes and cap deduct reports
Assists in the planning,  and implementing of physician and staff education programs related to new treatment modalities for various disease states, Medicare Part B and & D drugs, and  pharmacy utilization management best practices
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
Actively involved with various vendors and works closely with the Contracting Team on pharmacy related contracts
 
 

Required Qualifications:


PharmD - Current and unrestricted Pharmacist License for the State of CA is required
Must have one of the following: Completion of a one (1) year Ambulatory / Clinical pharmacy residency program; OR  2+ years of Clinical Pharmacy Experience with IPAs, medical groups or in a direct patient contact role (inpatient / ambulatory care)
Preferred Qualifications:


MTM (Medication Therapy Management) Certification is a plus
Current Geriatric Licensure or in process of obtaining is a plus: CGP – (Certified Geriatric Pharmacist)
BCPS – Board Certified Pharmacotherapy Specialist
HEDIS and CMS star rating experience is a plus
Bilingual in Spanish is a plus
Prior oncology / chemotherapy experience is a plus
Experience with Medicare Part B and Part D
Experience with pharmacy benefit managers (PBMs)
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system 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, Pharm-D, Managed Care, PBM, MTM, Ontario, CA, Riverside County, California