Pharmacy Director - Community and State KY Market

UnitedHealthcare; Louisville (KY); Remote; USD 106,000 - 195,000; Full time

Job summary

An established industry player is seeking a Pharmacy Director to lead Medicaid Health Plan initiatives. This role is pivotal in overseeing drug benefits, ensuring compliance with regulations, and managing pharmacy programs. You'll collaborate across departments, analyze financial trends, and drive innovative solutions to enhance healthcare delivery. With the flexibility of remote work in Kentucky, this position offers an exciting opportunity to impact the lives of Medicaid members positively. Join a mission-driven team committed to health equity and improving healthcare access for all.

Benefits

Comprehensive Benefits Package

Incentive Programs

Stock Purchase Options

401k Contributions

Qualifications

• 3+ years of clinical pharmacy experience or 2+ years in managed care.
• Experience with Medicaid/Medicare plans and government contracts.

Responsibilities

• Oversee drug benefit programs and formulary management.
• Collaborate for benefit changes and regulatory compliance.
• Analyze financials and conduct cost-benefit analyses.

Skills

Clinical Pharmacy

Analytical Skills

Strategic Thinking

Project Management

CPT/HPCS Coding

Education

Registered Pharmacist License in KY

Tools

Microsoft Office

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 equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.

Position Overview: This role involves providing outstanding service to our Medicaid Health plans and members, requiring a mix of business skills, technical expertise, industry knowledge, and clinical fortitude.

The Pharmacy Director for the KY Medicaid Health Plan is responsible for the execution, administration, and oversight of drug benefits, operations, programs, and initiatives aligned with company goals, regulatory obligations, and ensuring timely access to affordable care for Medicaid members. This leadership role involves strategic, financial, clinical, relationship, and organizational responsibilities, including oversight of pharmacy programs, formulary management, utilization reviews, analytics, and quality initiatives. The director manages the pharmacy benefits manager (PBM) contractual obligations, benefit operations, service levels, and escalations.

If located in Kentucky, you will have the flexibility to work remotely* while tackling significant challenges.

Primary Responsibilities:

1. Develop and execute strategic plans ensuring compliance with state and federal regulations.
2. Collaborate across departments for benefit changes and regulatory compliance.
3. Oversee drug benefit programs, including formulary management and clinical initiatives.
4. Partner with PBM teams to resolve operational issues and improve quality.
5. Analyze financials, rebates, and trends for planning.
6. Conduct cost-benefit analyses to support decision-making.
7. Build relationships with internal teams and serve as the primary contact for pharmacy services.
8. Create and maintain state-specific policies and materials.
9. Serve as SME for formulary, prior authorization, and coding requirements.
10. Utilize knowledge of health plan operations to improve performance metrics.
11. Identify growth and innovation opportunities.
12. Support RFPs and market analyses.
13. Monitor utilization and identify cost-effective alternatives.
14. Coordinate reports and data analytics for compliance and performance monitoring.
15. Assist health services and medical teams in meeting objectives.
16. Communicate program changes to stakeholders.
17. Engage with Medicaid and pharmacy associations.
18. Participate in relevant committees and reviews.
19. Address pharmacy-related issues and foster collaborations with the state.
20. Uphold UnitedHealth's cultural values.
21. Perform other duties as assigned.

We offer a rewarding environment with clear performance expectations and development opportunities.

Required Qualifications:

1. Current, unrestricted Registered Pharmacist license in KY.
2. 3+ years of clinical pharmacy, sales, or account management experience, or 2+ years in managed care/pharmacy residency.
3. Experience with Medicaid/Medicare plans and government contracts.
4. Knowledge of CPT/HPCS coding.
5. Strong clinical and analytical skills, with proficiency in Microsoft Office and health economics.
6. Ability to facilitate meetings and manage large projects.
7. Strategic thinking and innovative problem-solving skills.

*Remote work is contingent on adherence to UnitedHealth Group's Telecommuter Policy.

The salary range is $106,800 to $194,200 annually, based on various factors. Benefits include a comprehensive package, incentive programs, stock purchase options, and 401k contributions.

Our mission is to help people live healthier lives and improve the health system. We are committed to equity and addressing health disparities, reflecting our enterprise priorities.

UnitedHealth Group is an Equal Employment Opportunity employer and a drug-free workplace. Candidates must pass a drug test before employment.