The Account Manager Pharmacist role serves as the primary point of contact to the Pharmacy Management program for the Community Plan health plan management team related to execution of the pharmacy benefit program. In this role you will be accountable to be the primary point of contact to manage the ongoing contract relationship, conduct pharmacy benefit analysis to support the provision of clinically appropriate, high quality, cost effective pharmaceutical care for Health plan members. This position is an integral part of the UnitedHealthcare Pharmacy team, reporting to the Regional Pharmacy Director for Plan Management. Primary Responsibilities:Build and maintain client relationships and serve as the primary point of contact for overall and day-to-day service with local UHC plan Build strong working relationships with Plan CEO, COO, CFO and Medical Director Assist plan on all pharmacy related activities including clinical program development and improving member satisfaction Responsible for understanding and assuring compliance with the state contract and the rules governing pharmacy (formulary/PDL, UM, member communications, etc.) Accountable for creation and maintenance of state specific polices Service as the SME SPOC for benefit and coding requirements and responsible for communication to appropriate internal stakeholders for implementation Develop a strong working knowledge of health plan operations (compliance, finance, encounters, claims adjudications, networks, clinical, case management, HEDIS measures, etc.) Collaborate with internal partners to complete projects and to address on-going pharmacy service needs of the plan Analyzing, reviewing, forecasting, trending and presenting information for operational and business planning Communicates pharmacy program changes with the assigned health plans key departments Support Plan short and long term operational / strategic business activities by maintaining operational information Attend State Medicaid meetings and build relationship with the State pharmacy team Attend state pharmacy and health plan association meeting and build relationships Responsible for the timely submission of accurate pharmacy reports and deliverables Support the assigned health plans Grievances Department in the processing of grievances, appeals, fair hearings, etc., as defined by the health plans process to ensure a timely decision by the plan Medical Director Support assigned health plans Health Services, Case Management and Behavioral Health areas regarding targeted members with specific pharmacy concerns
Required Qualifications:Current, unrestricted Pharmacist license in State(s) as required by contract A minimum of 3 years of Clinical Pharmacy, Sales, or Account Management experience or combination thereof Proficiency in Microsoft Office Suite, including Word, Excel and PowerPointPreferred Qualifications: A minimum of 3 years of experience in Managed Care Pharmacy either in a Health Plan or PBM Experience with Pharmacy Utilization Review At least 1 year of direct experience with Medicaid/Medicare plans Understanding pharmacy trends Understanding of health plan - PBM contracts and pricing Understanding and interpretation of state contract language Experience building and maintain client relationships and networking Experience developing and implement clinical program to reduce trend or improve member experience Demonstrated ability to assist with focusing activities toward a strategic direction Ability to develop tactical plans, drive performance and achieve targets Problem solving skills; the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from othersCareers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 6 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can 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: Pharmacist, Account Manager, Clinical, Pharmacy, Managed Care, Medicaid, Medicare, Medical, Health Plan, PBM, Phoenix, AZ, Arizona
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.