Sr. Director, Clinical Pharmacist - Clinical Quality Improvement - Telecommute

UHG Eden Prairie, MN

About the Job

No industry is moving faster than health care. And no organization is better positioned to lead health care forward. We need attention to every detail with an eye for the points no one has considered. The rewards for performance are significant. You'll help improve the health of millions. And you'll do your life's best work.(sm)

This role requires a strong foundation of clinical knowledge as well as a deep understanding of Medicare Star Ratings Part D improvement strategies, Medicare compliance and reporting requirements, clinical quality measurement, state and federal regulations, strong written and verbal communication skills, and the ability to advise and lead consulting engagements.


You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.


Primary Responsibilities:

  • Serve as a subject matter expert for Clinical Quality Performance Management and Improvement (e.g. Star Ratings, HEDIS®, CAHPS, HOS, etc.)
  • Provides leadership, accountability, and responsibility for business development for Quality Advisory Services practice
  • Demonstrates understanding of market trends and competition to ensure appropriate consulting offering position and growth
  • Lead and oversee business development efforts and strategy including creation, development, and implementation of innovative consulting solutions driven by trends, customer needs and ongoing operational needs within Quality Improvement
  • Drives growth, and go-to-market strategy, individual client deal strategies; serves as Clinical Quality subject matter expert
  • Identifies internal partnership targets and opportunities that align with Quality Advisory Services growth goals
  • Provide support and guidance for hospital quality improvement strategies, publicly reported measures, quality reviews, accreditation requirements and quality program development
  • Lead complex consulting engagements
  • Develop written proposals and power point decks to support business development and sales efforts
  • Assist with the development and execution of strategic plans to support quality improvement interventions
  • Support the development, launch and execution of new consulting offerings and technical tools managed by the clinical quality consulting practice group
  • Builds relationships with key client partners and executes on product delivery to ensure alignment with client goals to achieve seamless execution and service delivery


Required Qualifications:

  • Clinical pharmacist (PharmD)

  • 5+ years of experience with Medicare Part C and D operations and compliance policies (Appeals and Grievances, Medication Therapy Management program, Medication Adherence, etc.)

  • 3+ years of experience and accountability for driving Medicare Star Rating improvement for Part D measures (including experience with process improvement, best practices, vendor oversight, and provider and member-centric targeted interventions)

  • 3+ years PBM experience

  • Proven track record for Star Rating Part D measure improvement

  • Ability to travel up to 80% as required

Preferred Qualifications:

  • Health plan operations experience

  • Pharmacy practice experience in any or all of the following settings: hospital pharmacy, retail pharmacy, specialty pharmacy, long term care

  • Experience working with PDE files and conducting root cause analysis

  • Strong strategic, analytical and problem solving skills

  • Excellent negotiation, influencing, collaboration, and listening skills

  • Role models an expertise point of view

  • Demonstrated ability to work with senior leadership in identifying, accessing, developing, constructing, presenting, negotiating, closing, and managing large deals in healthcare

  • Demonstrated ability to effectively message, position and present information for client impact and influence

  • Proven ability to operate and effectively navigate in a highly complex, matrix environment

  • Ability to successfully negotiate complex internal operating environments with a high level of collaboration

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)


Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

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



Job Keywords: OptumInsght, Optum Advisory Services, PharmD, Clinical Quality Improvement, Medicare Part D, STARS, telecommute, telecommuting, telecommuter, work from home, travel, WFH, remote