Associate Director, FFS Medicaid Clinical Consulting - Columbia, SC

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 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 one or more 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 Associate Director of Clinical Consulting is accountable for direct management of a staff of clinical consultants and maintaining client satisfaction and retention.

*Position is expected to start in January 2027

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

Primary Responsibilities:

• 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, formulary compliance targets, and HEDIS & NCQA measures
• Formulates and delivers clinically-sound and fiscally responsible recommendations to clients based on trend
• Provides mentoring / coaching for Clinical Consultants 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
• Provide superior clinical consultation and clinical account management with a focus on client satisfaction, client retention, and trend management
• Comprehends and effectively explains 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, 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 license in the state of South Carolina
• 5+ years of pharmacy practice experience or equivalent
• 3+ years of client facing or clinical account management experience with 2+ years of providing formal client presentation
• 2+ years in a leadership position or equivalent
• Experience developing and delivering professional communications, presentations, and documentation for varied audiences
• Experience prioritizing customer-centric activities
• Experience creating high-performing teams
• Demonstrated solid clinical and analytic background
• Proven ability to successfully manage multiple clients simultaneously
• Proven basic competency in Microsoft Word, Excel, PowerPoint, Teams, and Outlook
• Ability and willingness to travel

Preferred Qualifications:

• MBA or similar advanced degree
• 5+ years of Managed Care and/or PBM experience
• Proven formalized sales skills training
• Proven formalized leadership skills training
• Proven formalized presentation skills training

Competencies and Best Practice for High Performers (List competencies and at least two behavioral anchors for each):

• Generally, work is self-directed and not prescribed
  • Ability to works without guidance; seeks guidance on only the most complex tasks
  • Translates concepts into practice
  • Works with less structured, more complex issues
• Serves as a resource to others
  • Coach, provides feedback, and guides others
  • Provides explanations and information to others on difficult issues
  • Communicates effectively both orally and written Strong communication, presentation, interpersonal, and computer skills
  • Team player    
• Ability to translate clinical recommendations to member and client impact
  • Knowledgeable about drug development pipeline and new generics
  • Expert on industry best practices
  • Is up to date and stays updated on treatment and practice guidelines
  • Thoroughly knowledgeable on clinical program outcomes
  • Understand client population and disease burden
  • Is familiar with clinical rules for formulary management and clinical edits
  • Ability to bring new ideas and creative thinking to multiple business situations
• Understands operations and financial terms of contracts (i.e. including clinical performance guarantees, rebate guarantees, and generic dispensing rate guarantees)
  • Understands financial impacts to client and OptumRx of formulary, benefit and clinical program changes (including rebates, administrative costs and client profitability)
  • Has detailed knowledge of pricing concepts, terminology, and applications to business situations
  • Able to analyze & interpret claims data, cost drivers, trends, and patterns
  • Understands PBM and pricing terminology
  • Understands book of business trends
  • Understands implications of making various benefit and clinical program changes
  • Able to apply understanding of pricing to resolve pricing questions and issues
  • Able to interpret financial material provided to the account team
  • Understands fraud, waste & abuse requirements, clinical quality programs and initiatives, and other clinical aspects of the program
• Client relationship and customer service mindset
  • Is highly responsive to internal and client requests, questions, and communications
  • Is proactive; anticipates client needs and trends
  • Targets messages to varied audiences based on client experience

*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 $112,700 - $193,200 annually based on full-time employment. We comply with all minimum wage laws as applicable.

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.    

UnitedHealth Group 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.    

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