Pharmacy Care Coordinator

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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

Hours/Location : Must reside in Pacific or Mountain Time Zone. Variable hours to work 8-hours within the hours of 8:30 AM - 6:00 PM Pacific Standard Time Monday - Saturday based on business needs.

These efforts collectively promote clinical efficacy, cost-efficiency, and improved patient outcomes. Broad-based and comprehensive knowledge is critical to success in this role. You'll need to be well-versed in medical and pharmacy claims data.

You'll enjoy the flexibility to work remotely * from anywhere within Pacific or Mountain Standard Time Zones in the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Medication Access: Support access to medications by evaluating benefit options following UM (utilization management) determinations, including coverage denials or redirections. The role involves structured investigations to determine coverage under both medical and pharmacy benefits according to payer guidelines and plan requirements. Key tasks include confirming patient insurance eligibility and evaluating coverage standards across different benefits. This process may require examining prior authorization requirements, formulary placement, site-of-care policies, and potential patient cost implications
• Care Coordination: Work closely with physicians, advanced practice providers, nurses, pharmacists, and other healthcare professionals to promote coordinated care and effective medication management. The position requires proactive communication with other healthcare professional via phone, fax, and other electronic channels
• Cross-Functional Team Collaboration: Collaborate with various cross-functional teams to implement strategic projects that improve care delivery and network operations, ensuring compliance and maintaining high clinical standards. These teams span areas such as pharmacy management, utilization management, payment integrity, claims processing, health economics, finance, and contracting
• Compliance and Regulatory Requirements: Adhere to organizational policies related to affordability programs, patient confidentiality, and medication safety. Follows relevant regulatory guidelines, policies and procedures in reviewing clinical documentation (e.g., SOP's and Job Aids)
• Continuous Improvement: Engage in quality improvement activities and process enhancements aimed at increasing the efficiency and impact of affordability program
• Additional Duties:
  • Applies a team approach to solve complex problems
  • Adapt team priorities to ensure task completion
  • Serves as a primary point of contact and provides explanations for members, providers, and internal partners regarding processes, roles and responsibilities within their department
  • Prepare medication utilization and prior authorization requests for specialty oncology and non-oncology ambulatory injectable and/or infusion medications as related to member benefits, health plan coverage, site of service, and evidence based clinical guidelines
  • Solves moderately complex problems and/or conducts moderately complex analyses and translates concepts into practice
  • Provides explanations and information to others on issues
  • Identifies incomplete/inconsistent information in medical records and label missing measures/metrics/concerns as well as evaluate documentation of prior authorization
  • Coordinates auditing tasks as assigned
  • Verifies necessary documentation is included in medical records
  • Develops learning objectives based on appropriate analyses (e.g., business analysis, task analysis, audience analysis)
  • Engages/collaborates with appropriate stakeholders, leaders and SMEs to complete appropriate training content (e.g., products, processes, tools, skills needed)
• Performs all other related duties as assigned

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:

• High School Diploma/GED (or higher)
• Current, clear, and unrestricted Pharmacy Technician licensure in the U.S. state of residence
• 5+ years of pharmacy experience
• 2+ years of managed care, health plan, or PBM experience s
• 2+ years of experience with extensive knowledge of Medicare Part B and Part D, particularly pharmacy record review, claims, billing, and reimbursement rules
• 2+ years of experience with working knowledge of medical terminology, including ICD-9, ICD-10, and CPT codes
• 2+ years of experience with working knowledge of HIPAA Privacy and Security Rules and CMS security requirements
• 2+ years of experience working collaboratively in multidisciplinary teams within a matrixed organization
• 2+ years of experience demonstrating excellent interpersonal skills, including independent communication with healthcare professionals and patients in virtual or telehealth settings
• 2+ years of experience demonstrating strong written communication skills, with a consistent ability to deliver work free from typographical or spelling errors
• 2+ years of experience performing work with minimal supervision in a remote setting
• Intermediate level of proficiency in the Microsoft Office suite, including Outlook, Teams, and Excel

Preferred Qualifications:

• An associate degree or higher in a health-related field, including healthcare administration
• Active Certified Pharmacy Technician (CPhT) and/or Advanced Certified Pharmacy Technician (CPhT-Adv) certification
• Experience in specialty infusion care delivery, inclusive of home infusion operations
• Intermediate or higher level of proficiency with Epic EHR in ambulatory care settings
• Excellent operation skills demonstrated by a significant record of performance (i.e., meeting or exceeding operational goals) in health care quality and cost management
• Bilingual fluency in English and Spanish

*All Telecommuters 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 hourly pay for this role will range from $17.98 to $32.12 per hour 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.

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