Account Consultant Pharmacist - Remote in HI Only

UnitedHealth Group; Honolulu (HI); Remote; USD 113,000 - 193,000; Full time

Benefits offered by this job

Remote work flexibility

Benefits package

Job summary

UnitedHealthcare’s Plan Pharmacy Director in Hawaii leads pharmacy strategy, policy, and program execution for the Medicaid health plan. You will oversee PDL implementation, reporting, and state relationships, acting as the pharmacy SME to internal and external stakeholders.

The role requires Hawaii pharmacist licensure, 1+ years in managed care or Medicaid/Medicare, and strong communication. Remote work flexibility is offered; salary range reflects leadership impact.

Qualifications

• B.S.Pharm or Pharm.D degree and Hawaii pharmacist license.
• 1+ years of Clinical Pharmacy, Sales, or Account Management experience.
• 1+ years in Managed Care Pharmacy (Health Plan or PBM).
• 1+ years of direct Medicaid/Medicare plan experience.
• Experience presenting to groups including senior management.
• Strong skills with pharmacy data, Utilization Review, and trends.

Responsibilities

• Execute pharmacy benefit and compliance per state contract and regulations.
• Develop and drive strategic plans using managed care and PBM knowledge.
• Analyze forecasting and trend information for planning.
• Provide strategic direction and financial impact analysis for the plan.
• Build relationships with internal/external partners; be main contact for Pharmacy.
• Support clinical program development and member satisfaction improvements.
• Ensure policy creation and maintenance at the state level.
• Serve as SME for formulary, prior authorization, and benefit coding.
• Communicate changes across health plan departments.
• Engage Medicaid, pharmacy, and health plan associations meetings.
• Ensure timely submission of pharmacy reports to Medicaid and plan.

Skills

Verbal and written communication

Microsoft Office Suite

Education

B.S.Pharm or Pharm.D

Tools

Microsoft Office Suite

Job description

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together.

Providing outstanding service to our Medicaid Health plans takes a solid mix of business skills, technical proficiency, and industry knowledge. We have a strong team of pharmacists and pharmacy service specialists, and we are looking for a talented individual to join us as we grow our business. In this position, our new team member will have the opportunity to develop expertise in the Medicaid and DSNP business. The Plan Pharmacy Director serves as the primary point of contact and is accountable to the UnitedHealthcare Community Plan of Hawaii Plan leadership and the state Medicaid agency related to execution of the pharmacy benefit program and strategy.

Position is Plan Pharmacy Director, a dedicated resource and key staff of the UnitedHealthcare Community Plan of Hawaii health plan; that is accountable for setting the strategic direction, operational execution, oversight and financial impact analysis of pharmacy program priorities for the health plan. The role includes preferred drug list (PDL) implementation and maintenance activities, pharmacy reporting, management of state pharmacy relationship, active engagement at pharmacy related meetings with internal and external stakeholders as the pharmacy subject matter expert, key contact for pharmacy to internal and external stakeholders, developing and executing pharmacy strategy, ensuring pharmacy benefit compliance, communicating pharmacy trends and value proposition, developing and executing on affordability initiatives, supporting clinical and quality initiatives. This position will be part of the UnitedHealthcare Community and State Pharmacy team, reporting directly into the Regional Director Pharmacy Services.

If you are in the State of Hawaii, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities:

• Executes the pharmacy benefit and compliance with the state contract, state policies, and state/federal statutes and regulations governing pharmacy
• Utilizes broad understanding of managed care and PBM knowledge to develop, execute, and drive strategic plans and goals
• Analyzes forecasting and trend information for operational and business planning
• Provides strategic direction, operational oversight, and financial impact analysis as it pertains to pharmacy program priorities for the health plan
• Builds and maintain strong relationships with internal and external partners and serve as the primary point of contact for Pharmacy and Pharmacy Services
• Assists plan on all pharmacy related activities including clinical program development and improving member satisfaction
• Accountable for creation and maintenance of state specific polices
• Serves as the SME SPOC for formulary, prior authorization and benefit coding requirements and execution and responsible for communication with stakeholders for implementation
• Demonstrates a strong working knowledge of health plan operations (compliance, finance, encounters, claims adjudications, networks, clinical, case management, HEDIS measures, etc.)
• Collaborates with internal partners to complete projects and to address on-going pharmacy service needs of the plan
• Conducts and manages outcomes of various studies that include analyzing, reviewing, forecasting, trending, and presenting information for operational and business planning
• Communicates pharmacy program changes with the assigned health plans key departments
• Provides strategic solutions using the baseline pharmacy capabilities library to support plan priorities across various domains
• Engages state Medicaid, pharmacy and health plan association meetings and build relationships as the health plan pharmacy subject matter expert
• Ensures timely submission of accurate pharmacy reports and deliverables as required by the state Medicaid agency and the health plan
• Supports the health plan departments to ensure resolution of pharmacy related issues
• Learns, understands and lives the United cultural values
• Understands actions and communication relevant to changes and/or updates in relevant policies, procedures, and regulations
• Trains and educates team and internal stakeholders on relevant policies and procedures related to the pharmacy benefit
• Other duties 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:

• B.S.Pharm or Pharm.D
• Current, unrestricted Hawaii Pharmacist license
• 1+ years of Clinical Pharmacy, Sales, or Account Management experience or combination thereof
• 1+ years of experience in Managed Care Pharmacy either in a Health Plan or PBM
• 1+ years of direct experience with Medicaid/Medicare plans
• Experience in engaging, and presenting, to groups including senior level management
• Experience working with pharmacy data and experience with Pharmacy Utilization Review and understanding pharmacy trend
• Intermediate to advance proficiency in Microsoft Office Suite, including Word, Excel and PowerPoint
• Proven excellent verbal and written communication skills
• Proven 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 others
• Proven highly motivated and self-directed
• Proven excellent time management, organizational, and prioritization skills and ability to balance multiple priorities

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

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.

UnitedHealth Group 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.

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