Pharmacy Care Coordinator – Remote in West Region

UnitedHealth Group•El Segundo, CA

12h•Remote

About The Position

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.

Requirements

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 experiences
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

Nice To Haves

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

Responsibilities

Support access to medications by evaluating benefit options following UM (utilization management) determinations, including coverage denials or redirections.
Confirm patient insurance eligibility and evaluate coverage standards across different benefits.
Work closely with physicians, advanced practice providers, nurses, pharmacists, and other healthcare professionals to promote coordinated care and effective medication management.
Collaborate with various cross-functional teams to implement strategic projects that improve care delivery and network operations, ensuring compliance and maintaining high clinical standards.
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).
Engage in quality improvement activities and process enhancements aimed at increasing the efficiency and impact of affordability program.
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.