Quality Manager Clinical Pharmacy - Telecommute in Georgia

UHG Macon, GA

About the Job

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)


The Quality Manager, Clinical Pharmacy is responsible for engaging our network providers and local pharmacies in discussions related to Part D quality measures and programs primarily for our Medicare and Retirement business.  Performance management is tracked by designated provider metrics, inclusive minimally of 4 STAR gap closure and improved quality.  The person in this role is expected to work directly with our clinical quality team, providers and pharmacies to build relationships, ensure effective education and share reporting specifically focused on Part D measures. They will proactively identify performance improvement opportunities through data analysis and discussion with subject matter experts; and influence provider behavior to achieve needed results.


If you are located in Georgia, you will have the flexibility to telecommute* as you take on some tough challenges.


Primary Responsibilities: 

  •  Functioning independently, travel across state of Georgia to meet with providers to discuss Optum and UHC tools and programs focused on improving the quality of care for Medicare Advantage Members specifically focusing on medication adherence and high risk medications
  • Strategize with our Optum and United HealthCare quality team in the development of training and analytical materials for Stars and HEDIS, with a primary focus of medication adherence
  • Engage and collaborate with pharmacies; including the independent pharmacies across the state, to improve medication adherence of Medicare Advantage Members
  • Establish positive, long - term, consultative relationships with physicians, medical groups, IPAs and ACOs
  • Develop comprehensive, provider-specific plans to increase their HEDIS and Part D performance and improve their outcomes
  • Participate in Clinic days to address members with multiple gaps and perform medication reconciliations
  • Provide ongoing strategic recommendations, training and coaching to provider groups and pharmacies on program implementation and barrier resolutio
  • Act as lead to pull necessary internal resources together in order to provide appropriate, effective provider education, coaching and consultation; training will include Stars measures (HEDIS / CAHPS / HOS / med adherence), Optum program administration, and use of plan tools, reports and systems
  • Provide reporting to health plan leadership on progress of overall performance of pharmacy measures, gap closure, and use of virtual administrative resource
  • Facilitate / lead monthly or quarterly meetings, as required by plan leader, including report and material preparation
  • Provide suggestions and feedback to Optum and health plan
  • Provide clinical knowledge to our providers of chronic disease states in particular diabetes, hypertension and hyperlipidemia and changes in pharmacy practice in adult and geriatric patient populations to serve as an authoritative information source on drugs and their utilization in therapy
  • Deliver high quality evidence - based therapeutic recommendations to providers
  • Work collaboratively with health plan market leads to make providers aware of Plan - sponsored initiatives designed to assist and empower members in closing gaps
  • Role includes up to 75% state - wide travel (bit more travel within southern GA
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 Pharmacist license in Georgia
  • 1+ year direct experience working to close quality measurement gaps and strong working knowledge of clinical standards of care, preventive health, and Stars measures
  • 5+ years of healthcare / pharmacy industry experience
  •  Proficiency with Microsoft Word, Excel, Outlook and PowerPoint
  • 1+ year of Medicare market experience
  •  Ability to travel state-wide up to 75%

Preferred Qualifications:

  • Pharm D degree
  • 1+ year of community pharmacy experience
  • Stars or HEDIS experience
  • Provider facing experience
  • MTM skills with Outcomes and Mirixa platforms
  • Experience working with network and provider relations / contracting
  • Strong knowledge of EMR
  • Consulting experience
  • Data analytics experience
  • Strong relationship building skills

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)

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.



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.

Keywords: pharmacist, Georgia, GA, telecommute, work from home, remote