At UnitedHealthcare, we are on a mission to streamline the health care journey, foster healthier communities, and dismantle barriers to high-quality care. Your contributions here will positively influence the lives of millions. Join us in shaping the future of health care—one that is more adaptable, affordable, and just. Together, let’s embark on a journey of Caring. Connecting. Growing together.

Delivering exceptional service to our Medicaid Health Plans and their members requires a unique blend of business acuity, technical knowledge, industry insight, and clinical expertise.

The Pharmacy Director for our Ohio Medicaid Health Plan plays a crucial role in administering, executing, and overseeing drug benefits and related operations that meet regulatory obligations while ensuring Medicaid members have timely access to affordable care. This position demands strategic, financial, clinical, relationship, and organizational leadership to guide the Medicaid health plan and its stakeholders. You will oversee all facets of pharmacy and drug benefit programs, managing formulary design, utilization reviews, reporting and analytics, and quality improvement initiatives. Working alongside Health Plan leaders and Shared Services, you will also manage the pharmacy benefits manager (PBM), ensuring compliance and service quality for our Health Plan.

If you reside in Ohio and have the ability to travel approximately 10% of the time, you’ll have the flexibility to work remotely from anywhere within the U.S. while tackling significant challenges.

Key Responsibilities:

• Leverage your extensive knowledge of managed care, health plan operations, and PBM to formulate and implement strategic objectives while ensuring adherence to state and federal regulations.
• Collaborate across departments to ensure timely integration of benefit changes and compliance with cross-departmental initiatives involving providers and stakeholders to drive desired business and clinical outcomes.
• Lead the development and management of the drug benefit, focusing on formulary management and utilization management strategies for pharmaceuticals, including clinician-administered medications.
• Partner with PBM teams to address plan-specific requirements, troubleshoot operational issues, and implement quality improvement strategies.
• Analyze and present financial information related to drug costs, forecasts, and trends to support both short- and long-term planning.
• Conduct financial and cost-benefit analysis to support decision-making and align priorities with the strategic roadmap of the company and health plan.
• Cultivate robust relationships with internal partners and serve as the go-to person for plan pharmacy and drug services.
• Create and maintain tailored state policies, programs, and documentation as necessary.
• Act as the primary subject matter expert on formulary, prior authorization, and benefit coding, ensuring effective communication with all stakeholders.
• Utilize your understanding of health plan operations to develop and scrutinize performance metrics, continuously enhancing quality and efficiency.
• Work with internal partners to identify growth opportunities, innovative projects, and initiatives that improve member and provider experiences.
• Liaise with shared services to provide insights for Requests for Proposals (RFPs) and competitive market evaluations as needed.
• Monitor medication usage to identify cost-effective alternatives and enhance quality through analysis of claims data.
• Prepare and deliver accurate reports and analytics for all drug benefits and services, ensuring compliance with health plan and regulatory requirements.
• Support Health Services, Medical Directors, and other partners in achieving organizational goals and improving key performance metrics.
• Communicate updates on drug programs to all relevant internal and external stakeholders.
• Engage with State Medicaid and health associations to foster collaborative relationships.
• Participate in Agency meetings related to Pharmaceuticals and Therapeutics (P&T) and Drug Utilization Review (DUR) as requested.
• Assist health plan partners in resolving pharmacy-related issues and advance advocacy efforts within the state.
• Embody and promote the cultural values of UnitedHealthcare.
• Perform other duties as assigned.

You will be recognized and rewarded for your performance in a supportive environment that guides you toward success and offers development opportunities.

Required Qualifications:

• Current, unrestricted Registered Pharmacist license and residency in Ohio.
• Minimum of 3 years of relevant experience in Clinical Pharmacy, Sales, or Account Management, or a combination thereof; alternatively, at least 2 years of experience in Managed Care Health Plans or a PBM residency.
• Experience with Medicaid/Medicare plans.
• Intermediate to advanced proficiency in Microsoft Office Suite, particularly Word, Excel, and PowerPoint.
• Advanced analytical skills, with a background in pharmacy/medical analytics and health economics.
• Familiarity with government contracts/programs within a PBM or health plan framework.
• Understanding of medical drug CPT/HCPCS coding.
• Strong clinical insight to interpret evidence-based guidelines and complex data for program development.
• Effective facilitator with the ability to present information to diverse audiences.
• Capable of managing large-scale, cross-functional projects with minimal supervision.
• Strong critical thinking, creative problem-solving, and strategic planning skills.
• Willingness to travel locally about 10% of the time.
• Valid driver’s license and reliable transportation.

Preferred Qualifications:

• Pharm D degree.

All remote employees must comply with UnitedHealth Group’s Telecommuter Policy.

Compensation for this position ranges from $106,800 to $194,200 annually based on full-time employment. Pay varies based on factors such as local market conditions, education, experience, and certifications. Our comprehensive benefits package includes a range of incentives, equity stock purchase options, and a 401k contribution, subject to eligibility requirements. Regardless of where you start your journey with UnitedHealth Group, you’ll find a broad array of benefits and incentives.

At UnitedHealth Group, we strive to enhance people’s health and improve the overall health system. We are committed to ensuring that everyone, regardless of race, gender, sexuality, age, location, or income, has the opportunity to lead their healthiest life. We recognize the existing barriers to health, particularly those faced by marginalized communities, and we actively work to deliver equitable care and tackle health disparities, reflecting our core mission.

Click apply for complete job details.