MGR Clinical Pharmacist - Health Plan Services

Explore opportunities with Kelsey-Seybold Clinic, part of the Optum family of businesses. Work with one of the nation's leading health care organizations and build your career at one of our 40+ locations throughout Houston. Be part of a team that is nationally recognized for delivering coordinated and accountable care. As a multi-specialty clinic, we offer care from more than 900 medical providers in 65 medical specialties. Take on a rewarding opportunity to help drive higher quality, higher patient satisfaction and lower total costs. Join us and discover the meaning behind Caring. Connecting. Growing together.  

Under general supervision of the Director of Pharmacy, Health Plan Services, this position manages the clinical pharmacy section of the division, including developing, monitoring, evaluating, and coordinating clinical pharmacy services that promote desirable patient outcomes. Responsibilities include the development, implementation and maintenance of quality improvement initiatives, fiscal controls, management of human and capital resources, and risk management functions for the clinical pharmacy program. Does related patient care work as required. Possesses excellent skills in planning, time management and organization; skills in researching pharmacology literature; ability to work independently and adapt to a changing work environment; ability to implement new systems and procedures; ability to make correct decisions in stressful situations; ability to communicate effectively both orally and in writing; ability to relate well to a broad spectrum of staff, physicians and patients; ability to effectively develop and present in-service modules; ability to think critically and analyze and solve problems; ability to effectively use computer applications such as spreadsheets, word processing, calendar, e-mail and database software in performing work assignments; ability to read, write, speak, understand, and communicate in English sufficiently to perform the essential duties of the position; sound professional judgment, thoroughness, accuracy, integrity, and resourcefulness.

Primary Responsibilities:

• Establishes, coordinates, implements, and provides all aspects of clinical pharmacy activities with emphasis on therapeutic drug monitoring, clinical pathways, and patient outcomes. Leads clinical pharmacy program enhancement and better practices within the department. This position requires an understanding of the strategic impact of the pharmacy program for the company and knowledge of how the programs integrate with other company initiatives. Develops and implements policies, practices and procedures for clinical pharmacy services, ensuring compliance with clinical practice standards
• Assists the Director in developing operational systems and procedures for the Pharmacy Department's Clinical Division that are in accordance with federal, state, and local laws and regulatory standards. Good knowledge of the principles and concepts of administration and management. Development and implementation of quality improvement initiatives, fiscal controls, management of human and capital resources, formulary management, and risk management functions for the clinical pharmacy program
• Communicates with physicians and other healthcare personnel to clearly discuss general and specific medication recommendations, therapies for cost-effective care, general drug/disease information, and educate about health plan prescription drug benefits. Report program progress and updates to medical directors and team. Collaborates with physicians in establishing disease and drug criteria for the safe, economical, and appropriate use of medications within clinical programs
• Supervises clinical pharmacy staff who provide patient-focused pharmaceutical care, performing the full range of supervisory functions, including performance evaluations; staffing plans; training and development; assignment, review and approval of work; leave approvals; disciplinary matters; team building; recruitment; etc. Communicates instructions to internal and external individuals and/or departments. Furnishes and obtains information from other entities/vendors
• Coordinates, monitors and/or develops reports to ensure accuracy and timely review, in addition to responding to any inquires made concerning Clinical services within the department. Monitors Performance Reports. Monitor daily duties and program work queues to ensure program requirements and department goals are achieved. Create program reports weekly, monthly, quarterly, annually or upon request from management. Communicate program and staff concerns to management. Perform audits and monitoring. Reports risks to management. Assists in the development, monitoring, and maintenance of all Clinical Pharmacy Operations in compliance with drug and disease state guidelines as well as HEDIS and/or CMS regulations. Uses computer applications or other automated systems such as spreadsheets, word processing, calendar, e-mail and database software in performing work assignments; May perform other incidental tasks, as needed
• Coordinates, monitors and/or develops reports to ensure accuracy and timely review, in addition to responding to any CMS inquires made concerning Clinical services within Part D. Monitors Part D Performance Reports. Create program reports weekly, monthly, quarterly annually or upon request from management. Communicate program and staff concerns to management. Perform audits. Reports risks to management
• Provides clinical services and cross-coverage for fellow clinical staff as needed. Thorough knowledge of the modern principles, practices, and concepts of modern pharmacology, and pharmacotherapeutics and its practical application. Interprets and applies drug data, and recommends dosing regimens based on patient's medical history and disease state, ensuring optimal patient care; Provides patient education and counseling; Communication with physician regarding drug therapy, patient counseling, medication reconciliation within EMR and follow-up with member. Answer inbound calls and conduct outbound calls. Accesses protected health information (PHI) in accordance with departmental assignments and guidelines defining levels of access (i.e. incidental vs. extensive). Triage patient emergencies and provides the appropriate follow up as needed
• Able to work independently and adapt to a changing work environment; think critically and analyze and solve problems; able to make correct decisions in stressful situations; ability to read, write, speak, understand, and communicate in English sufficiently to perform the essential duties of the position; Uses sound professional judgment, thoroughness, accuracy, integrity, and resourcefulness to complete tasks
• Provide training, education and oversight of pharmacy residents and assigned interns. Assists with development, enhancement, and maintenance of clinical operational functions, policy and procedures, pharmacy clinical support, and provider of education to KSC, KCA, and KCA members. Ensures prompt and courteous customer service by all Health Plan Pharmacy Services personnel. Clinically support interdepartmental staff such as member services, sales, and marketing, as needed. Attends meetings asdesignated and completes any other duties deemed necessary to support Pharmacy Health Plan Services activities. Provides clerical support for Part D duties and audits. Provides administrative and clinical support for special projects
• Participates in the generation of new knowledge relevant to the practice of pharmacotherapy, clinical pharmacy and medicine; Educates health care professionals, students, patients, and the public regarding rational drug therapy; Retrieves, analyzes, evaluates, and interprets the scientific literature, and serves as the resource person for patient and population-specific drug information to health professionals and patients

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:

• Graduate of School of Pharmacy with Pharm D.(Doctorate of Pharmacy) degree
• Current and Active Pharmacy License Texas State Board of Pharmacy Registered Pharmacist
• 5+ years of Medicare Part D experience, or 5+ years of HMO 3rd Party Managed Care experience or 5+ years of pharmacy management or 5+ years of Clinical pharmacist activities
• Customer Service experience
• Auditing experience
• Good Alpha/Numeric data entry skills with minimal errors
• Proficient with computer applications that include, but not limited to: Microsoft Wordand Excel
• Demonstrated multitasking skills and solid problem solving & analytical skills
• Problem Solving - to conceptualize, design, evaluate, and report

Preferred Qualifications:

• Completion of accredited PGY-1 Pharmacy Practice or Managed Care Pharmacy Residency Program
• Pharmacy Board Certification
• Ability to read, write, speak, understand, and communicate in English sufficiently to perform the essential duties of the position
• Ability to communicate with internal and external staff at all levels of management including but not limited to VPs, directors and/or managers, and other clinic operational and clinical managers on clinical policies and procedures, programs, initiatives, progress, results, and strategies
• Ability to communicate with Health Plan Pharmacy Department personnel to delegate duties, inform about policies, educate, coach, discipline
• Ability to communicate with members and physicians to handle complaints and problems, assist with clinical questions, recommend medications/products related to particular disease state, and educate about health plan prescription drug benefits
• Ability to write reports (i.e., weekly/monthly) which but not limited to maintenance of audit logs, Patient Safety Measure, HEDIS, Clinical programs, claims adjudication, Coverage determinations. Detail oriented with good verbal and written communication skills, interpersonal skills, professional appearance, and ability to work effectively in a fast-paced work environment
• Stress Tolerance - maintain accuracy, productivity, and judgement in stressful situations; ability to think critically and analyze and solve problems independently

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $112,700 to $193,200 annually based on full-time employment. We comply with all minimum wage laws as applicable.

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.

OptumCare is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.