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Associate Director Clinical Consulting, Medicaid

1 month ago

Nashville, United States UnitedHealth Group Inc. Full time

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

This Associate Director of Clinical Consulting will oversee clinical consulting client relationships, proactively identify clinical solutions, and manage clinical resource allocation for the Public Sector of OptumRx's segments of Clinical Consulting support. They will work with clinical leadership in developing a strategy related to the delivery of proactive consultative services and driving clinical upsell targets, including deployment of appropriate use guidelines and protocols, utilization management strategies, clinical products / services and formulary management strategies. The Associated Director of Clinical Consulting is expected to maintain strategic relationships with client leaders, key stakeholders, and brokers/consultants. The Director of Clinical Consulting is accountable for direct management of a staff of clinical consultants and maintaining client satisfaction and retention.

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

Primary Responsibilities:

* Lead and motivate a team of Clinical Consultant Pharmacists to deliver results
* Provides mentoring / coaching for Clinical Consultants in order to enhance employee engagement, promote professional development and maintain high levels of staff satisfaction
* Assist in the recruitment, on-boarding and mentoring of new Clinical Consultant team members
* Determine and manage clinical consulting resource allocation and assignment
* Provide routine reporting to clinical leadership regarding milestone attainment and any significant issues within their segment that may be impacting overall team performance
* Maintains understanding of individual client contracts and ensures proper execution of all clinical deliverables specific to those agreements
* Ensures alignment of PBM clinical priorities with strategic goals and objectives of the overall organization and client
* Collaborates with clients to establish achievable but aggressive clinical program goals, including generic dispensing rate improvements, implementation of utilization management programs, improvement in medication adherence rates, improvements in therapy gaps for key chronic disease states, PDL and or formulary compliance targets, and HEDIS & NCQA measures
* Formulates and delivers clinically-sound and fiscally responsible recommendations to clients based on trend
* Provide superior clinical consultation and clinical account management with a focus on client satisfaction, client retention, and trend management
* Comprehends and effectively explains PDL and formulary and clinical program changes to clients
* Stays aware of and provides clinical market intelligence to clients
* Provides education for clients, pharmacists, members and physicians per contractual requirements
* Communicates drug information to clients and responds to plan-specific clinical inquiries in a timely manner
* Supports other revenue-enhancement efforts (e.g., specialty, formulary, PDL, UM, mail, etc…) in coordination with client mgmt./sales teams where appropriate
* Routinely collaborates with client management leadership peers to provide well-coordinated, impactful quarterly performance review sessions with clients
* Serves a key resource for new clinical product/service ideation and liaison to clinical product development / management areas to create new or enhance existing programs
* Identifies and collaborates with account management on clinical renewal strategies
* Drives enhanced client relationships through senior-level strategic discussions and planning which addresses issues of highest priority for the client
* Consistently looks at existing processes, methods, and materials to find opportunities for improvement
* Maintains strategic relationships with client leaders, key stakeholders, and brokers/consultants
* Supports sales and marketing including participating in RFP/finalist activities as needed based on current standard operating procedure
* Serves as Subject Matter Expert (SME) for other departments on Clinical Consulting-specific issues/inquiries
* Actively participates in, and in some cases leads departmental and interdepartmental workgroup and project work

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:

* Bachelor of Science in Pharmacy or Doctor of Pharmacy degree
* Active, unrestricted US state-specific pharmacist license in the state of Tennessee
* 5+ years of pharmacy practice experience
* 3+ years of clinical account management experience within a PBM, Managed Care or State insurance plan, interfacing with external clients (beyond patients and prescribers) and delivering formal client presentations
* 3+ years of direct management experience, leading teams to deliver results
* 2+ years of Medicaid experience including PDL and formulary experience with Medicaid UM development and public health policy experience
* Basic competency in Microsoft Word, Excel, PowerPoint, Teams, and Outlook
* Ability and willingness to travel up to 20%
* Primary residence in the state of Tennessee

Preferred Qualifications:

* MBA or similar advanced degree
* Formalized sales skills training
* Formalized leadership skills training
* Formalized presentation skills training
* Well-rounded clinical account management experience working across multiple lines of business including Commercial and Government clients
* Experience working with complex government clients w/complex benefit structures
* Experience communicating with executive leadership
* Conflict resolution experience
* Medicare D experience
* Medicaid Fee-For-Service experience
* All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

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.

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.

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