Yuma, Arizona
Glen Burnie, Maryland
Posted: 28-Dec-24
Location: Colorado Springs, Colorado
Categories:
Internal Number: 145449065
For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together.
We are seeking a Senior Pharmacy Care Coordinator.
Hours: Willing to work between the hours of 8am to 6pm Mountain or Pacific Standard time. This is a 40 hour a week position Monday through Friday. The schedule will be determined by the supervisor upon hire.
You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
- Consults with and coordinates initial set up of and on-going requests for medication prior authorization, scheduling Pharmacist consultation meetings, and documenting outcomes in a professional manner
- Communicates directly with providers/designees when appropriate to gather all clinical information to assist in determination ofthe medical necessity of requested healthcare services and refers to appropriate staff for higher level of review when indicated
- Prepares utilization reviews of professionally administered medications using InterQual/Milliman and criteria and verifies benefits for services using health plan benefits and coverage
- Manages and follows relevant time limit standards necessary for conducting and communicating utilization review determinations in collaboration with UM pharmacists
- Documents and communicates in a professional and compliant manner within the appropriate electronic health record, by telephone or fax to support medication reviews, adherence, or other pharmacy care management initiatives
- Prepares for oversight audits by the health plans and responds to documentation requests as directed
- Follow up with ancillary contracted entities if services or resources have not been made available to the member to assure that pharmaceutical needs are being met
- Makes appropriate care management referrals through triage process during care transition to case management staff
- Reviews written requests for clinical services for necessary documentation and forwards to Utilization Management Pharmacist or Medical Director when necessary
- Interfaces with referring practitioners or staff, to facilitate prescribing of pharmaceutical alternatives within specified time restrictions
- Participates in process improvement projects and team meetings as required
- Responds to questions from medical offices, hospitals, and members about the necessary steps of the medical and pharmaceutical referral authorization processes and medication copay assistance alternatives
- Assists with preparation of utilization review authorizations, both verbal and written to assure high continuity of care for all managed care members in the program and consistency of gathering specific information within the department to comply with policies and procedures
- Works closely with members, member’s family, and interdisciplinary team to ensure proper information is disseminated to all stakeholders in a compliant fashion
- Works closely with the UM Clinical Pharmacy Manager to obtain timely decisions on pended referrals and requests for medical services from health plans and providers as needed
- Other duties as assigned
What are the reasons to consider working for UnitedHealth Group? Put it all together - competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:
- Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
- Medical Plan options along with participation in a Health Spending Account or a Health Saving account
- Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage
- 401(k) Savings Plan, Employee Stock Purchase Plan
- Education Reimbursement
- Employee Discounts
- Employee Assistance Program
- Employee Referral Bonus Program
- Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)
- More information can be downloaded at: http://uhg.hr/uhgbenefits
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)
- 3+ years of Pharmacy or Healthcare related experience
- 2+ years of experience in any of the following: a patient facing healthcare role, experience with Utilization Review, medical or pharmacy management for Insurance or Community Based facility
- Intermediate level of computer proficiency with Microsoft Office applications including Word, Excel, Teams, and Outlook) Be able to use multiple web applications at one time
- Ability to work between the hours of 8am to 6pm Mountain or Pacific Standard time
Preferred Qualifications:
- Advanced Education (i.e. Associate’s or Bachelor’s degree)
- Pharmacy Technician or MA license in good standing, in any state
- CPhT certification
- Experience in managed care pharmacy (Pharmacy Benefits Manager, Medicare Advantage)
- Experience using EMR systems
- Knowledge of Medicare part B
- Knowledge of HIPAA
*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
California, Colorado, Connecticut, Hawaii, Maryland, Nevada, New Jersey, New York, Rhode Island, Washington, Washington, D.C. Residents Only: The hourly range for this role is $19.47 to $38.08 per hour. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
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.
Diversity creates a healthier atmosphere: OptumCare 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.
OptumCare is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
#Green, #RPO
