Pharmacy Director - Remote in Ohio - Community and State
Company: UnitedHealthcare
Location: Dublin
Posted on: May 8, 2025
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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.
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Providing outstanding service to our Medicaid Health plans and
members takes a solid mix of business skills, technical expertise,
industry knowledge, and clinical fortitude.
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The Pharmacy Director for the Ohio Medicaid Health Plan is
responsible for the execution, administration, and oversight of the
drug benefits, operations, programs, and initiatives that align
with company goals, comply with contractual and regulatory
obligations, and ensure that Medicaid members have timely access to
affordable care and services. The Pharmacy Director provides
strategic, financial, clinical, relationship, and organizational
leadership for the Medicaid health plan, its leadership team, and
stakeholders. -The role exercises broad strategic and operational
oversight for planning, organizing, and directing all aspects of
pharmacy and drug benefit programs, including clinician
administered drugs and programs, preferred drug list(s) or
formulary design and maintenance, utilization reviews, reporting &
analytics, and quality initiatives. In partnership with Health Plan
leaders and Shared Services, the Pharmacy Director is responsible
to manage and oversee the pharmacy benefits manager (PBM)
contractual accountabilities, benefit operations, service levels,
and escalations for their Health Plan. -
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If you are located in the state of Ohio and able to travel about
10% of the time, you'll enjoy the flexibility to work remotely *
from anywhere within the U.S. as you take on some tough challenges.
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Primary Responsibilities:
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
Work cross-functionally across departments to ensure timely
implementation of benefit changes, regulatory requirements, and
cross-departmental initiatives with providers, members, and other
stakeholders to achieve business and clinical outcomes
Develop, implement/execute, and oversee the drug benefit including
formulary management, administration, monitoring, reporting,
communication, clinical programs, and utilization management
strategies for pharmaceuticals, including clinician administered
drugs
Partner with the PBM account team to coordinate Plan specific PBM
pharmacy requirements and resolve implementation issues and ongoing
operational issues through root cause analyses, resolution
execution, and continuous quality improvement disciplines
Analyze, review, and present pharmacy/drug financials, drug
rebates, forecast, and trend information for operational and
business planning (short and long term)
Conduct financial impact analysis and cost-benefit analysis (CBAs)
to inform decision-making, enhance strategic roadmap(s), and
align/accelerate company and health plan priorities
Build and maintain solid relationships with internal cross
department partners and serve as the primary point of contact for
Plan pharmacy/drug services
Create and maintain state specific polices, programs, collaterals,
artifacts, etc.
Serves as the Plan SME single point of contact for formulary, prior
authorization, and benefit coding requirements and execution and
responsible for communication with stakeholders for implementation
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Have a solid working knowledge of health plan operations
(compliance, finance, encounters, claims adjudications, networks,
clinical, case management, HEDIS measures, etc.) to develop and
analyze efficiency and quality metrics and improves performance on
a continuous basis
Collaborate with internal partners to identify, prioritize, and
execute key growth, innovative projects, member and provider
experience and affordability opportunities to address on-going
needs of the plan, Medicaid members, and providers
Collaborate with shared services partners to provide content and
proof points to support Requests for Proposals (RFP), bids, and
competitive market checks on the PBMs and competitors as
circumstances dictate
Monitor under and over-utilization of pharmaceuticals and identify
opportunities for cost-effective alternatives, vendor
administration, and quality improvement through approved/denied
claims, prior authorization volume, and step therapy effectiveness
with timely claims review to ensure appropriate adjudication at
point of sale
Coordinate production and submission of timely reports and data
analytics as required for, but not limited to, all drug benefits
and services, compliance dashboard, regulatory requirements,
productivity, clinical operations, benefit changes, implementation,
and service quality monitoring, etc. as required by health plan,
Medicaid Agency, regulators, auditors, etc.
Assist Health Services team, Medical Directors, and other health
plan partners with activities to meet departmental and organization
objectives and implementing action plans to address issues and
improve key performance indicators and select utilization,
economic, and quality outcomes
Communicate drug program changes with all impacted external and
internal parties
Engage with State Medicaid, pharmacy and health plan Associations,
and other key stakeholders to strengthen relationships
Attend the Agency Pharmaceutical & Therapeutics (P&T) Committee
and Drug Utilization Review (DUR) Commission meetings, and other
forums as requested
Support health plan partners to ensure timely resolution of
pharmacy/drug related issues, advance advocacy efforts, and foster
deeper collaborations with the state
Learns, understands and lives the United cultural values
Other duties as assigned
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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:
Current, unrestricted Registered Pharmacist license and residing in
Ohio
3+ years of progressively responsible and direct work experience of
Clinical Pharmacy, Sales, or Account Management experience or
combination thereof with the duties and responsibilities as
described above OR a minimum of 2 years of experience in Managed
Care Health Plan or PBM or Managed Care Pharmacy residency
Direct experience with Medicaid/Medicare plans
Intermediate to advance proficiency in Microsoft Office Suite,
including Word, Excel and PowerPoint
Advance analytics and data skills, with experience and knowledge of
pharmacy/medical analytics and health economics outcomes
research
Experience with government contracts/programs in a PBM or health
plan
Knowledge of medical drug CPT/HPCS coding
Solid clinical knowledge and ability to interpret evidence-based
guidelines, complex clinical information, claims data, and
regulatory requirements to deliver product and program development
solution
Ability to effectively facilitate meetings and deliver
information/presentations to management, regulators, or
partners
Ability to direct, implement, and manage large-scale, complex,
cross-functional, multi-departmental projects to completion, with
performance (leading and lagging) KPIs, and minimum supervision
Ability to think critically, creatively, and work strategically, to
help drive innovative solutions yielding measurable results to the
organization
Ability to travel locally 10% of the time based on business
needs
Driver's license and access to reliable transportation
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Preferred Qualifications:
Pharm D
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*All employees working remotely will be required to adhere to
UnitedHealth Group's Telecommuter Policy
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The salary range for this role is $106,800 to $194,200 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
al 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.
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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. -
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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. - - -
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Keywords: UnitedHealthcare, Fairfield , Pharmacy Director - Remote in Ohio - Community and State, Accounting, Auditing , Dublin, Ohio
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