Senior Retail Medication Prior Authorization Coordinator

Optum; Everett (WA); Hybrid; USD 57,308,000 - 103,155,000; Full time

Benefits offered by this job

Paid Time Off

Medical Plan options

Dental, Vision, Life & AD&D Insurance

401(k) Savings Plan

Education Reimbursement

Employee Discounts

Employee Assistance Program

Employee Referral Bonus Program

Voluntary Benefits

Job summary

UnitedHealth Group's Optum unit seeks a Senior Retail Medication Prior Authorization Coordinator to review and process medication prior authorizations per insurer guidelines. The role blends on-site training in Everett, WA with eventual remote work, requiring a commutable distance to Everett for training.

The ideal candidate has 1+ year in pharmacy settings, strong PHI handling, and familiarity with health plans.

Qualifications

• High School Diploma or GED required.
• 1+ year Pharmacy Technician or Medical Assistant experience or 1+ year in a pharmacy setting.
• 1+ year of basic computer software experience.
• Must reside commutable to Everett, WA or be willing to commute for training.
• Access to a quiet home workspace and ability to protect PHI.

Responsibilities

• Acquire and maintain knowledge of health plan formulary and authorization requirements.
• Use internal systems to speed up authorization turnaround.
• Gather chart review data to submit prior auth requests to insurers.
• Act as liaison between providers, pharmacy, health plans and patients.
• Provide status updates to providers, pharmacy and patients.
• Document all authorization work in the EHR per guidelines.
• Record denials and alternatives when applicable.
• Ensure compliance with all laws and policies governing prior authorizations.

Skills

Attention to detail

Time management

Communication

Team collaboration

Education

High School Diploma/GED

WA Certified Medical Assistant License (preferred)

Tools

EPIC

Job description

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 diversity and inclusion, 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.

Optum's Pacific West region is redefining health care with a focus on health equity, affordability, quality, and convenience. From California to Oregon and Washington, we are focused on helping more than 2.5 million patients live healthier lives and helping the health system work better for everyone. At Optum Pacific West, we care. We care for our team members, our patients, and our communities. Join our culture of caring and make a positive and lasting impact on health care for millions.

The Senior Retail Medication Prior Authorization Coordinator is responsible for reviewing and processing request for prior authorization of medication in accordance with insurance provider guidelines. This role requires a solid understanding of healthcare insurance policies, pharmacy benefit management, and medical terminology.

Schedule: Monday-Friday, 8am-5pm PST

Location: Onsite for training at 7600 Evergreen Way, Everett WA for about 1-3 month training period and then will become fully remote.

Candidates must reside near Everett, WA or must be willing and able to commute to the Everett office at their own expense for training

If you reside near Everett, WA, you will enjoy the flexibility to telecommute* as you take on some tough challenges

Primary Responsibilities

• Acquire and maintain a working knowledge of health plan formulary and authorization requirements
• Utilize internal system to facilitate faster turnaround time on a complete authorization
• Gather necessary information from chart review to submit prior auth request to insurance providers
• Act as a liaison between providers, pharmacy, health plans and patients to support a timely medication authorization process
• Communicate with providers, pharmacy, and patients to provide updates on the status of their prior auth request
• Document in the patient electronic health record all medication authorization work provided following standard work guidelines
• Provide and document in Epic medication authorization denials and health plan recommendation and or alternatives when provided
• Ensure compliance with all relevant laws, regulations, and policies related to medication prior authorizations
• Performs 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.

• 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.)

Required Qualifications

• High School Diploma/GED
• 1+ years of Pharmacy Technician or a Medical Assistant experience OR 1+ year(s) of experience in a pharmacy setting
• 1+ years of experience with basic computer software and keyboarding
• Reside within a commutable distance to Everett and surrounding communities in Washington
• Access to a designated quiet workspace in your home (separated from non-workspace areas) with the ability to secure Protected Health Information (PHI)
• Live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service

Preferred Qualifications

• Current certification from WA State Department of Health as a Certified Medical Assistant or WA State Pharmacy Technician License
• Knowledge of EMR (EPIC)
• Proficiency with keyboarding, documentation, and processing prior authorizations

Soft Skills

• Ability to work independently and maintain good judgment and accountability
• Demonstrated ability to work well with health care team
• Strong organizational and time management skills
• Ability to multi-task and prioritize tasks to meet all deadlines
• Ability to work well under pressure in a fast-paced environment
• Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying information in a manner that others can understand, as well as ability to understand and interpret information from others
• 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 salary for this role will range from $20.00 to $36.00 hourly 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.

#RPO #GREEN