Pharmacy Director - Community and State KY Market - 2280349

UnitedHealth Group; Louisville (KY); Hybrid; Confidential; Full time

Job summary

An established industry player is seeking a Pharmacy Director to lead the Medicaid Health Plan in Kentucky. This pivotal role involves overseeing drug benefits and operations, ensuring compliance with regulations, and driving strategic initiatives to enhance care quality and affordability. The successful candidate will utilize their expertise in managed care and pharmacy benefit management to implement effective programs, analyze financial impacts, and foster relationships with stakeholders. Join a team committed to improving health outcomes and making a meaningful difference in the lives of Medicaid members while enjoying the flexibility of remote work options.

Benefits

Comprehensive Benefits Package

Performance Recognition

Development Opportunities

Qualifications

• Extensive experience in managed care and pharmacy operations.
• Strong analytical skills for financial and drug utilization analysis.

Responsibilities

• Oversee drug benefit programs and ensure compliance with regulations.
• Develop strategic plans for pharmacy operations and cost management.
• Collaborate with internal teams for timely benefit changes and initiatives.

Skills

Managed Care Knowledge

Pharmacy Benefit Management (PBM)

Formulary Management

Financial Analysis

Clinical Program Development

Education

PharmD or equivalent

MBA or Master's in Public Health

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.

The Pharmacy Director for the KY Medicaid Health Plan is responsible for the execution, administration, and oversight of drug benefits, operations, programs, and initiatives that align with company goals, comply with contractual and regulatory obligations, and ensure timely access to affordable care and services for Medicaid members. The role provides strategic, financial, clinical, relationship, and organizational leadership for the Medicaid health plan, its leadership team, and stakeholders. It involves broad oversight of pharmacy and drug benefit programs, including formulary management, utilization reviews, reporting, analytics, and quality initiatives. The Pharmacy Director manages the pharmacy benefits manager (PBM) contractual accountabilities, benefit operations, service levels, and escalations.

If located in Kentucky, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities:

1. 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.
2. Work cross-functionally across departments to ensure timely implementation of benefit changes, regulatory requirements, and initiatives with providers, members, and other stakeholders to achieve business and clinical outcomes.
3. Develop, implement, and oversee the drug benefit including formulary management, administration, monitoring, reporting, communication, clinical programs, and utilization management strategies for pharmaceuticals, including clinician administered drugs.
4. Partner with the PBM account team to coordinate Plan-specific PBM pharmacy requirements and resolve implementation and operational issues through root cause analyses and quality improvement disciplines.
5. Analyze, review, and present pharmacy/drug financials, drug rebates, forecasts, and trend information for planning purposes.
6. Conduct financial impact and cost-benefit analyses to inform decision-making and align strategic priorities.
7. Build and maintain relationships with internal partners and serve as the primary contact for Plan pharmacy/drug services.
8. Create and maintain state-specific policies, programs, and artifacts.
9. Serve as the Plan SME for formulary, prior authorization, and benefit coding requirements, communicating with stakeholders for implementation.
10. Possess a solid working knowledge of health plan operations to develop and analyze efficiency and quality metrics.
11. Collaborate on growth, member/provider experience, and affordability projects.
12. Support RFPs, bids, and market analysis related to PBMs and competitors.
13. Monitor drug utilization and identify opportunities for cost-effective alternatives and quality improvement.
14. Coordinate reports and data analytics on drug benefits, compliance, clinical operations, and quality monitoring.
15. Assist health plan teams in meeting objectives and improving performance indicators.
16. Communicate drug program changes and engage with stakeholders and regulatory bodies.
17. Attend relevant committee meetings and forums.
18. Support pharmacy-related issue resolution, advocacy, and collaboration with the state.
19. Adhere to UnitedHealth Group’s cultural values and policies.
20. Perform other duties as assigned.

We offer a rewarding environment with performance recognition, development opportunities, and a comprehensive benefits package. The salary range for this role is $106,800 to $194,200 annually, based on experience, location, and other factors.

Our mission is to help people live healthier lives and make the health system work better for everyone, committed to equity, environmental responsibility, and addressing health disparities.