Clinical Pharmacy Supervisor – Enterprise Care and Value Pharmacy

WellMed, part of the Optum family of businesses, is seeking a  Supervisor, Clinical Pharmacy to join our team in San Antonio, TX. Optum is a clinician-led care organization that is changing the way clinicians work and live. 

As a member of the Optum Care Delivery team, you’ll be an integral part of our vision to make healthcare better for everyone. 

At Optum, you’ll have the clinical resources, data and support of a global organization behind you so you can help your patients live healthier lives. Here, you’ll work alongside talented peers in a collaborative environment that is guided by diversity and inclusion while driving towards the Quadruple Aim. We believe you deserve an exceptional career, and will empower you to live your best life at work and at home. Experience the fulfillment of advancing the health of your community with the excitement of contributing new practice ideas and initiatives that could help improve care for millions of patients across the country. Because together, we have the power to make health care better for everyone. Join us and discover how rewarding medicine can be while Caring. Connecting. Growing together.  

Position in this function is under general supervision of the Director of Clinical Pharmacy, the Supervisor of Clinical Pharmacy is responsible for completing prior authorization functions as needed for WellMed Managed Care Patients. This position will also work with UM nurses as a Clinical Pharmacist and the Medical management P&T Committee. The Supervisor of Clinical Pharmacy is also responsible to follow processes to improve patient care, outcomes, and quality improvement metrics related to CMS HEDIS/Star ratings. This position will provide clinical, administrative, and leadership support to assigned staff in accordance with policies and procedures.  

Role is hybrid. Candidate needs to be able to travel to office

Primary Responsibilities:

• Manages and evaluates direct report staff including training and staff onboarding
• Manages the compliance for Part B Pharmacy prior authorization queues to meet established performance metrics
• Provide timely review for WellMed members by processing prior authorization and medical necessity requests for specialty CMS part B medications
• Review specialty medication prior authorization requests (i.e. biopharmaceuticals) according to established treatment protocols, clinical criteria, member benefits. and make determinations within the defined turnaround times and meet regulatory requirements
• Knowledgeable of current and emerging clinical trends
• Active participation in various clinical departmental meetings and forums to improve clinical programs, enhance processes, and share clinical information
• Continuously look for ways to streamline and improve workflow
• Assist with user acceptance testing for new clinical programs and system enhancements
• Ensure and evaluate quality controls and implement opportunities for performance improvement in pharmacy practice specific to specialty pharmacy
• Serves as a clinical resource and consultant in all areas of pharmacy and medication management
• Research drug information to maintain drug knowledge and disease state understanding for application to prior authorization reviews
• Supports medical management and pharmacy quality initiatives
• Follow all policies and procedures related to job
• Ensures all direct reports remain up to date and in compliance with all education, training, and regulatory requirements. Develops corrective action plans to address gaps as needed
• Actively participates in process improvement planning and implementation while fostering good communication and collaboration across all affected departments 
• Assist  with  routine audits on UM clinical reviews and claims to ensure adherence to CMS and NCQA regulations/guidelines
• Assist with gathering, analyzing and interpreting data and metrics to evaluate effectiveness of Enterprise Care & Value Pharmacy programs/initiatives
• Assist with the development of policies, procedures, workflows, job aids, and other key documents related to Enterprise Care & Value Pharmac
• Serves as a subject matter expert (SME)  for process/workflow related questions 
• Assist with the development and implementation of all  Enterprise Care & Value Pharmacy projects and initiatives
• Performs all other related duties as assigned to meet departmental objectives

In 2011, WellMed partnered with Optum to provide care to patients across Texas and Florida. WellMed is a network of doctors, specialists and other medical professionals that specialize in providing care for more than 1 million older adults with over 16,000 doctors’ offices. At WellMed our focus is simple. We’re innovators in preventative health care, striving to change the face of health care for seniors. WellMed has more than 22,000+ primary care physicians, hospitalists, specialists, and advanced practice clinicians who excel in caring for 900,000+ older adults. Together, we’re making health care work better for everyone. 

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:

• Doctor of Pharmacy degree
• Current Pharmacist license to practice in the applicable state
• 2+ years of experience as a Prior Authorization Pharmacist or Clinical Pharmacist, conducting such activities as medication therapy management, clinical rounds, disease state management, etc. Relevant experience includes ANY of the following or a combination thereof:
  • Retail pharmacy
  • Pharmacy Benefit Management 
  • Infusion or hospital pharmacy experience 
• 2+ years of pharmacy leadership experience inclusive of project management/leadership, cross-functional collaboration/work to accomplish initiatives, etc.
• Proven excellent written and verbal communication skills
• Proven excellent relationship building skills
• Proven planning and organizational skills to demonstrate leadership and initiative
• Proven solid analytical and PC operation skills
• Proven ability to travel as necessary (local, 25%)

Preferred Qualifications:

• Ability to obtain additional  pharmacist licensure  based on business needs
• Board certification by the Board of Pharmacy Specialties (BPS)
• Certified Geriatric Pharmacist
• Certification in Medication Therapy Management (MTM)
• Experience working with provider relations, working within various payor environments, and value-based care environments/arrangements (i.e.: managed care, commercial HMO, Medicare,
• capitated arrangements, etc.)
• Experience with Medicare guidelines
• Fluent in Spanish Language 

Physical & Mental Requirements:

• Ability to lift up to 10 pounds
• Ability to push or pull heavy objects using up to 20 pounds of force Ability to sit for extended periods of time
• Ability to stand for extended periods of time
• Ability to use fine motor skills to operate office equipment and/or machinery Ability to properly drive and operate a company vehicle
• Ability to receive and comprehend instructions verbally and/or in writing Ability to use logical 
  reasoning for simple and complex problem solving

The salary range for this role is $89,800 to $176,700 annually 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. 

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.