For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together.
You will play a crucial role in supporting specialty medication and infusion-related programs across the West region. This position partners with providers, nurses, operational teams, and market leaders to optimize medication utilization, evaluate treatment strategies, promote biosimilar and cost-effective therapy adoption, and improve the quality, affordability, and coordination of patient care across the continuum through direct and indirect patient care and care coordination activities for California and the West region (Arizona, Colorado, Idaho, Nevada, New Mexico, Oregon, Utah, Washington).
Hours/Location: Must reside in California. *Primarily remote position with occasional travel (up to 10%) within Southern California for site visits and business needs. Variable hours to work 8 hours within the hours of 8:00AM - 6:00PM Pacific Time Monday - Saturday based on business needs.
If you are located in California, you will have the flexibility to work remotely* as you take on some tough challenges.
Primary Responsibilities
- Clinical Program & Medication Optimization
- Lead prospective clinical review activities for specialty medications, infusions, and high-cost drug therapies to support appropriate utilization, affordability, and quality outcomes across the continuum of care
- Conduct clinical consultations and evidence-based recommendations regarding medication access, utilization management, and pharmaceutical stewardship initiatives to support medication-related changes, including dose, frequency, route of administration, and therapeutic substitutions
- Provide expertise regarding infusion protocols, medication administration considerations, monitoring requirements, and specialty drug operational workflows
- Evaluate specialty medication treatment plans to identify opportunities for clinically appropriate optimization, including benefit alignment, site-of-care selection, biosimilar utilization, formulary compliance, and cost-effective therapy alternatives
- Monitor and manage medication shortage, backorder, and recall processes, partnering with providers, pharmacies, infusion centers, and operational teams to mitigate supply disruptions and ensure continuity of patient care
- Establish relationships with physicians, nurses, infusion centers, specialty pharmacies, care management teams, and operational stakeholders to provide pharmaceutical consultation, clinical guidance, and strategic support to ensure effective implementation and adoption of medication management initiatives and best practices
- Strategy and Execution
- Support strategies that promote optimal medication sourcing and administration across care settings, including physician offices, infusion centers, home infusion, specialty pharmacy, and alternate sites of care
- Apply pharmacoeconomic principles and clinical expertise to balance patient outcomes, medication access, provider experience, and affordability objectives
- Assist with the development, implementation, and maintenance of policies, procedures, workflows, clinical guidelines, job aids, and operational documentation
- Evaluate quality controls, monitor program outcomes, and identify opportunities to improve operational performance, standardization, and clinical effectiveness
- Support implementation activities, user acceptance testing, workflow validation, and change management efforts associated with new programs and technologies
- Analyze medication utilization trends, medical and pharmacy claims data, and operational metrics to inform strategic recommendations and program enhancements
- Monitor specialty drug market trends, including biosimilar adoption, pipeline therapies, drug shortages, reimbursement changes, and evolving clinical guidelines
- Cross-Functional Team Collaboration:
- Establish and maintain solid partnerships with physicians, medical providers and staff, nursing leadership, ambulatory operations, procurement teams, infusion centers, specialty pharmacies, and market leaders
- Facilitate engagement with clinical and operational stakeholders to understand care delivery challenges, gather feedback, and support implementation of strategic initiatives
- Engage collaboratively with cross-functional teams to advance care delivery and network management, ensuring compliance and upholding clinical excellence These teams represent diverse functional areas such as pharmacy care management, utilization management, payment integrity, claims operations, health care economics, finance, and contracting
- Present clinical and operational findings to leadership and key stakeholders while providing actionable recommendations
- Demonstrate solid planning, organization, initiative, relationship-building, and communication skills to successfully lead complex, cross-functional projects
- Compliance:
- Ensure compliance with regulatory requirements, accreditation standards, organizational policies, and pharmacy practice guidelines
- Support audit readiness and maintain accurate, timely documentation in accordance with established procedures, clinical protocols, and standard operating procedures
- Perform all other related duties and activities as assigned to meet departmental objectives
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
- Doctor of Pharmacy degree from an ACPE-accredited school or college of pharmacy
- Successful completion of a PGY1 pharmacy residency program and at least one year of pharmacy experience, OR a minimum of three years of pharmacy experience in infusion or hospital pharmacy setting
- Current, clear, and unrestricted pharmacist licensure in California
- Experience in leading clinical operations, data analysis, report development, or program development within the health care field
- Comprehensive knowledge of clinical therapeutics for specialty drugs, including the use of infusions and injectables, with proficiency in literature evaluation and evidence-based medicine
- Familiarity with value-based care, including shared savings/risk models
- Proven solid written and verbal communication skills
- Proven solid analytical and computer skills
- Proven ability to build collaborative partnerships and influence stakeholders across a matrixed organization
- Must reside in California
Preferred Qualifications
- California Advanced Pharmacist Practitioner (APh) recognition in good standing
- Successful completion of a PGY2 pharmacy residency program or fellowship
- Active board certification through Board of Pharmacy Specialties (BPS) [eg, BCPS, BCACP, BCGP, BCOP]
- Current, clear, and unrestricted pharmacist licensure in one or more additional West region states, or willingness to obtain additional state licensure based on business needs Relevant states include Arizona, Colorado, Idaho, Nevada, New Mexico, Oregon, Utah, and Washington
- 2+ years of managed care, health plan, or PBM experience
- Experience in specialty infusion care delivery
- Experience practicing under a Collaborative Practice Agreement (CPA) with medication prescribing and management responsibilities
- Experience working with provider relations, multiple payor environments, and value-based care models, including commercial HMO, Medicare, capitated arrangements
- Intermediate or higher level of proficiency in Microsoft 365 applications, including Excel (pivot tables, xlookups, index match, countifs), Power BI, Outlook, and Teams
- Intermediate or higher level of proficiency in Epic EHR in the ambulatory care setting
- Proven excellent program and project management skills with demonstrated success meeting or exceeding operational, health care quality, and cost-management objectives
*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 $151,984 - $227,976 annually based on full-time employment. We comply with all minimum wage laws as applicable.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
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