Sr Pharmacy Care Coordinator - National Remote

Optum; Colorado Springs (CO); Remote; Full time

Job summary

Optum is seeking a Sr Pharmacy Care Coordinator to manage medication authorizations and support patient care. This national remote position allows you to work with an interdisciplinary team to ensure safe medication practices, impacting health outcomes positively. Join us for a fulfilling role in healthcare that offers flexibility and professional growth.

Benefits

Paid Time Off

Medical Plan options

401(k) Savings Plan

Education Reimbursement

Employee Discounts

Qualifications

• 2+ years of experience in clinical healthcare setting.
• 2+ years of experience with Prior Authorization in a pharmacy setting.
• Pharmacy Technician license preferred.

Responsibilities

• Coordinates medication prior authorization requests.
• Communicates with providers to gather clinical information.
• Conducts utilization reviews for medications.

Skills

Communication

Attention to Detail

Problem-Solving

Education

High School Diploma/GED

Job description

Sr Pharmacy Care Coordinator - National Remote

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Sr Pharmacy Care Coordinator - National Remote

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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 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.

The Sr Pharmacy Care Coordinator will collaborate with members, providers, and an interdisciplinary team focused on assuring safe and appropriate utilization of professionally administered medications. This role supports the UM pharmacist in providing urgent and routinely requested medication determinations in a time sensitive manner to help facilitate professionally administered medication treatments for Optum delegated members.

Schedule: Monday - Friday 8:30am - 5:30pm PST, with rotating Saturdays (approx. 8:00am - 12:00pm, once every 8 weeks)

You will enjoy the flexibility to telecommute* 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 of the 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 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
• 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
• 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
• Positions in this function consult with customers, members, patients, providers, internal departments and/or external third parties on any or all of the following:- Consult with and coordinate initial set up and on-going treatment plan for specialty drug patients, including DURs, co-pay assistance, ancillary products, scheduling Pharmacist consults and/or RN visits, and liaison with provider offices on labs, refill orders and prior authorizations
• Review and advise on medications and treatment plans (based on review of medical case notes, medication list and lab results) to improve outcomes and avoid potential drug interactions
• Discuss with patients life issues affecting medication adherence and provide advice on improving drug regimen compliance
• Advise patients on alternate Rx fill strategies of retail versus mail order and options for financial assistance
• May outreach to providers on suspected medication abuse situations
• Review medication regimen for disease state for LTC facilities/ hospice care / RN case managers / Medical Directors / clients and provide summaries and guidance on future medication plans. Advice may include alternate drug therapies, stopping a medication and/or lower cost alternative
• Review medical case notes to determine on-going medication treatment plan and project future medication costs
• Extensive work experience, possibly in multiple functions
• Work does not usually require established procedures
• Works independently
• Mentors others
• Acts as a resource for others
• Coordinates others' activities
  
  

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.)
  
  

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)
• 2+ years of experience in a clinical healthcare setting as Pharmacy Tech or Medical Assistant
• 2+ years of experience within Utilization Review function
• 2+ years of experience with Medicare, Medicaid, and commercial payor guidelines
• 2+ years of experience of Prior Authorization in a pharmacy setting
  
  

Preferred Qualifications

• Pharmacy Technician license in state of residence
• Remote working experience
• Knowledge of advanced clinical standards, practices, and procedures for designated member population
• Knowledge of, and skill in, the use of personal computers and Microsoft Office Suite
• Solid knowledge of pharmacy and medical terminology
• Proven solid customer Service, interpersonal and problem-solving skills
• Proven solid and clear verbal and written communication
• Proven solid attention to detail and ability to work efficiently using job aids for multiple platforms
• Proven ability to always maintain a positive teamwork attitude and professional demeanor
• Proven ability to work cohesively with team members, physicians, and medical staff
• Proven ability to plan, prioritize, and organize projects to meet the established objectives of the team
• All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
  
  

The salary range for this role is $19.86 to $38.85 per hour based on full-time employment. 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.

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

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.

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

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Other

• Industries

  Hospitals and Health Care

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