Pharmacy Director - Remote in IN Market Only

• Utilize deep and broad understanding of managed care, health plan operations, and PBM knowledge to develop, execute, and drive strategic plans and goals while ensuring compliance with the state contract and/or state/federal statutes and regulations
• Work cross-functionally across departments to ensure timely implementation of benefit changes, regulatory requirements, and cross-departmental initiatives with providers, members, and other stakeholders to achieve business and clinical outcomes
• Develop, implement/execute, and oversee the drug benefit including formulary management, administration, monitoring, reporting, communication, clinical programs, and utilization management strategies for pharmaceuticals, including clinician administered drugs
• Partner with the PBM account team to coordinate Plan specific PBM pharmacy requirements and resolve implementation issues and ongoing operational issues through root cause analyses, resolution execution, and continuous quality improvement disciplines
• Analyze, review, and present pharmacy/drug financials, drug rebates, forecast, and trend information for operational and business planning (short and long term)
• Conduct financial impact analysis and cost-benefit analysis (CBAs) to inform decision-making, enhance strategic roadmap(s), and align/accelerate company and health plan priorities
• Build and maintain solid relationships with internal cross department partners and serve as the primary point of contact for Plan pharmacy/drug services
• Create and maintain state specific polices, programs, collaterals, artifacts, etc.
• Serves as the Plan SME single point of contact for formulary, prior authorization, and benefit coding requirements and execution and responsible for communication with stakeholders for implementation
• Have a solid working knowledge of health plan operations (compliance, finance, encounters, claims adjudications, networks, clinical, case management, HEDIS measures, etc.) to develop and analyze efficiency and quality metrics and improves performance on a continuous basis
• Collaborate with internal partners to identify, prioritize, and execute key growth, innovative projects, member and provider experience and affordability opportunities to address on-going needs of the plan, Medicaid members, and providers
• Collaborate with shared services partners to provide content and proof points to support Requests for Proposals (RFP), bids, and competitive market checks on the PBMs and competitors as circumstances dictate
• Monitor under and over-utilization of pharmaceuticals and identify opportunities for cost-effective alternatives, vendor administration, and quality improvement through approved/denied claims, prior authorization volume, and step therapy effectiveness with timely claims review to ensure appropriate adjudication at point of sale
• Coordinate production and submission of timely reports and data analytics as required for, but not limited to, all drug benefits and services, compliance dashboard, regulatory requirements, productivity, clinical operations, benefit changes, implementation, and service quality monitoring, etc. as required by health plan, Medicaid Agency, regulators, auditors, etc.
• Assist Health Services team, Medical Directors, and other health plan partners with activities to meet departmental and organization objectives and implementing action plans to address issues and improve key performance indicators and select utilization, economic, and quality outcomes
• Communicate drug program changes with all impacted external and internal parties
• Engage with State Medicaid, pharmacy and health plan Associations, and other key stakeholders to strengthen relationships
• Attend the Agency Pharmaceutical & Therapeutics (P&T) Committee and Drug Utilization Review (DUR) Commission meetings, and other forums as requested
• Support health plan partners to ensure timely resolution of pharmacy/drug related issues, advance advocacy efforts, and foster deeper collaborations with the state
• Learns, understands and lives the United cultural values
• Other duties as assigned

• Current, unrestricted Registered Pharmacist license and residing in Indiana
• 3+ years of progressively responsible and direct work experience of Clinical Pharmacy, Sales, or Account Management experience or combination thereof with the duties and responsibilities as described above OR a minimum of 2 years of experience in Managed Care Health Plan or PBM or Managed Care Pharmacy residency
• Direct experience with Medicaid/Medicare plans
• Experience with government contracts/programs in a PBM or health plan
• Knowledge of medical drug CPT/HPCS coding
• Solid clinical knowledge and ability to interpret evidence-based guidelines, complex clinical information, claims data, and regulatory requirements to deliver product and program development solutions
• Intermediate to advance proficiency in Microsoft Office Suite, including Word, Excel and PowerPoint
• Proven advance analytics and data skills, with experience and knowledge of pharmacy/medical analytics and health economics outcomes research
• Proven ability to effectively facilitate meetings and deliver information/presentations to management, regulators, or partners
• Proven ability to direct, implement, and manage large-scale, complex, cross-functional, multi-departmental projects to completion, with performance (leading and lagging) KPIs, and minimum supervision
• Proven ability to think critically, creatively, and work strategically, to help drive innovative solutions yielding measurable results to the organization

UnitedHealth Group