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The Clinical Quality Pharmacist is responsible for creating and implementing data-driven pharmacy-based strategies and workplans that improve the health, well-being, and quality of care and service received by our members, as demonstrated by high quality measure performance in Part D and pharmacy-based HEDIS CMS Star measures. This role will use outreach, education, care reminders and Rx prescribing support, to engage patients and providers on the importance of Rx therapy and medication adherence. The role will collaborate with internal and external key stakeholders, regional operations, IPA practices, FQHCs, and other community partners, to drive clinical relationships and engagements between members and the care delivery system. The focus of this role is OneCare (Medi-Medi) pharmacy-based measure quality metric performance, which may include but is not limited to HEDIS, CMS Stars and Medicare Part D measure gap closure, and CAHPS/HOS patient experience performance.
The ideal candidate will be:
Self-directed, able to manage multiple priorities, and coordinate complex cross-functional project plans, to drive execution of strategies Accountable for demonstrating improvement in quality, patient experience and optimized patient outcomes Skilled at utilizing data to drive decisions and has a passion for applying technology to achieve systematic solutions Passionate about continuous improvement, streamlined processes and workflow optimization. Energized by new challenges, thrives in a fast-paced, dynamic environment, collaborates well in a collaborative atmosphere
If you are located in Irvine, CA, you will have the flexibility to work from home and in the office in this hybrid role* as you take on some tough challenges.
Primary Responsibilities:
Under direction of the Quality Medical Director and in collaboration with other stakeholders, the Clinical Quality Pharmacist will lead implementation of strategic pharmacy-based programs that improve the overall health and service provided to our OneCare patients. The goals of the program may include:Patient educational and reminder outreach calls to targeted patients (e.g., patients at risk of falling out of medication compliance for one or more medications, newly prescribed Statin Rx, PCP referrals)
Managing patient outreach registries Counselling and educating patients regarding pharmacy benefits, health plan network and other programs and tools available to help improve quality of lifestyle Establishing a plan for each patient and/or patient opportunity cohort Coordinating auto Rx refills, multi-month Rx conversions, and mail order Rx Discussing with patients life issues affecting medication adherence and providing advice on improving drug regimen compliance Advising patients on alternate Rx fill strategies of retail versus mail order and options for financial assistance Provider/Clinician engagement to targeted clinicians with high volumes of patients with Part D Rx gaps and those needing education on the new Polypharmacy: Use of Multiple Anticholinergic (ACH) Medications in Older Adults, and Polypharmacy: Use of Multiple Central Nervous System (CNS) – Active Medication in Older Adults measures
Providing clinician education on measure requirements Reviewing strategies to reinforce Rx therapy and support Medication Adherence Offering clinician prescribing assistance, such as Prescribing Protocol Agreements to initiate / modify Rx on their behalf Liaising with provider offices on labs, refill orders and prior authorizations Reviewing and advising on medications and treatment plans (based on review of medical case notes, medication list and lab results) to improve outcomes and avoid potential drug interactions Outreaching providers in suspected medication abuse situations Reviewing medication regimens for disease states and providing summaries and guidance on future medication plans Completing all documentation in a timely manner. Maintain quality of care standards as defined in workflow Optimize partnerships/ synergies with other accountable business units (e.g., Population Health, Provider Relations, Clinical Services, Marketing, Legal/Compliance, etc.)
Lead cross-team pharmacy-based program collaborations through detailed, time/role-specific project plans, to ensure clear consistent direction, communication, documentation, and division of responsibility Develop and implement strategies to improve quality and patient outcomes Provide Rx guidance and oversight of operational information and policy changes to internal departments Consistently support compliance by maintaining the privacy and confidentiality of information, protecting the assets of the organization, acting with ethics and integrity, reporting noncompliance, and adhering to applicable federal, state, and local laws and regulations, accreditation, and licenser requirements (if applicable), and current corporate and client policies and procedures Partner with leaders and other functional business areas and other duties and initiatives as assigned
You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:
Current California Pharmacist license without restrictions Experience working with programs in HEDIS Quality, Stars, CAHPS/HOS EMR proficient Proven excellent patient care and time management skills Proven flexible multi-prioritizing skills and time management skills Ability to work independently, without direct supervision Proven intermediate MS Office skills Demonstrated PowerPoint Presentation skills Proven excellent communication skills Fluency in Spanish
Preferred Qualifications:
Experience with managed healthcare / care delivery business operations Retail pharmacy experience
The hourly range for this role is $43.17 to $84.95 per hour based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.
Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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.
OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.