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 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.

As a Pharmacy Care Coordinator your primary responsibility will be to facilitate prior authorizations, review medical benefits and financial assistance for patients with acute and chronic disease states. You will prepare prior authorizations for submission, obtain support documents, follow up on outcomes and support any fee for service enhanced offerings related to Prior Authorizations. Additionally, you will handle medical benefit investigations and billing and complete financial assistance for patients with high out-of-pocket costs.

This position is full-time. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 7:00am – 7:00pm CST, Monday – Friday. It may be necessary, given the business need, to work occasionally overtime or weekends.

We offer 3 weeks of on-the-job training. The hours during training will be an 8-hour shift between 8:00am to 4:30pm CST, Monday - Friday. 

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Initiating PA requests
• Reviewing clinical documentation
• Reviewing provider PA submission preferences
• Validating insurance types (Medicaid, Medicare, Commercial, and/or Medical Coverage etc.)
• Accessing multiple Optum resources to check PA status and benefits
• Problem-solve with decisiveness and urgency and escalate to operations partners, team leads, management and other stakeholders
• Ensure patients and providers are supported by following escalation through to finish
• Enters notes/information into pharmacy processing system
• Focus on patient care and quality assurance
• Able to work flexible hours between 7-7pm CST Monday to Friday
• Stay updated on the latest changes and updates in benefit programs, policies, and regulations to ensure accurate benefit investigation
• Review and assess relevant documentation, such as medical records, insurance policies, and financial statements, to determine eligibility, coverage and Financial Assistance
• Collaborate with internal teams, such as account managers, claims processing and customer service, to ensure seamless coordination and delivery of benefits to eligible individuals
• Communicate with clients, healthcare professionals, and insurance representatives to obtain necessary information and clarify benefit details
• Maintain strict confidentiality and adhere to all privacy and security regulations when handling sensitive information

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 equivalent work experience
• 1+ year pharmacy customer service or healthcare industry experience
• Intermediate MS Office proficiency (Word, Excel, Outlook)
• Ability to work any of our 8-hour shift schedules during our normal business hours of 7:00am – 7:00pm CST, Monday – Friday. It may be necessary, given the business need, to work occasionally overtime or weekends
• Must be 18 years of age OR older

Preferred Qualifications:

• Prior Authorization Experience
• Medical Billing Experience
• Experience in pharmacy or healthcare

Soft Skills:

• Ability to work independently

Telecommuting Requirements: 

• Ability to keep all company sensitive documents secure (if applicable) 
• Required to have a dedicated work area established that is separated from other living areas and provides information privacy
• Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service

Soft Skills and Abilities:

• Ability to manage multiple tasks and set priorities
• Ability to establish and execute action plans; able to share your past successes
• Ability to be diplomatic when faced with conflict, and always communicate in a professional and courteous manner
• Ability to produce quality results with a detail-oriented focus
• General knowledge of pharmacy laws, practices and procedures
• Knowledge of insurance and third-party billing systems

*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 $18.00 to $32.00 per hour based on full-time employment. We comply with all minimum wage laws as applicable. 

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.

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