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Drug Utilization Review Clinical Pharmacist Nashville TN

Position Description

You're looking for something bigger for your career. How about inventing the future of health care? OptumRx is creating an innovative approach to Pharmacy Benefit Management. Here you will find a professional culture where you can use your talent and our resources to make an impact on a huge scale. Take this opportunity to start doing your life's best work.(sm)

This particular position is for the:

State of Tennessee

Department of Finance and Administration

Division of Health Care Finance and Administration

Bureau of TennCare

Request for Proposals for Pharmacy Benefit Management

The Drug Utilization Review (DUR) Clinical Pharmacist will be 100% dedicated to the Health Care Finance and Administration's ( HCFA) Medicaid Programs, TennCare, CoverRx, and CoverKids. The DUR Pharmacist shall be licensed by the State of Tennessee Board of Pharmacy.

Primary Responsibilities:

  • Preparing presentations and attending each quarterly meeting of the TennCare DUR Board
    • Gathering of data, analysis of results, developing recommendations, and presentation of such to the State and the TennCare DUR Board
  • Presenting Prospective DUR (Pro-DUR) and Retro-DUR data, findings, and utilization data, along with a class review at each meeting, using TennCare paid and denied claims, TennCare diagnosis and procedure codes, and information gathered from the State of Tennessee's Controlled Substance Monitoring Database
  • Organizing DUR Board meetings, including presiding at the meeting, preparing a PowerPoint presentation for each meeting, and working with the State to determine the agenda and content of each meeting
    • Scheduling and conducting a Pre-DUR meeting with appropriate State staff no less than four (4) weeks prior to the scheduled meeting
    • Presenting to the State the proposed agenda and meeting materials for approval and later posting on the TennCare and Contractor's websites
    • Scheduling a Post-DUR meeting with appropriate State staff no greater than two (2) weeks after the DUR meeting
    • Making the meeting minutes available for review no greater than four (4) weeks after the DUR meeting
  • Retro-DUR program coordination and maintenance with support by the Provider Liaison Pharmacists who are Tennessee-licensed pharmacists, and additional clinical reviewers who are also Tennessee-licensed pharmacists



Required Qualifications:


  • BS degree in Pharmacy or a PharmD
  • Current and unrestricted Pharmacist license in the state of Tennessee
  • 1+ years of experience working as a licensed Pharmacist
  • Proficiency in Microsoft Word, Excel, and Outlook
  • Formal presentations experience
  • Client facing or clinical account management experience



Preferred Qualifications:

  • Clinical analytical skills
  • PharmD
  • FeeForService Medicaid or Medicaid Managed Care experience
  • PBM experience
  • Experience with, or knowledge of, Pharmacy Advisory Committees, DURB (Drug Utilization Review Board), and/or P&T Committees
  • PBM Implementation experience



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: Drug Utilization Review, DUR, Clinical, Pharmacist, Nashville, TN, Tennessee

Drug Utilization Review Clinical Pharmacist Nashville TN

Nashville, TN
Full Time

Published on 06/15/2019