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.
The Pharmacy Care Coordinator - Care Team Associate (CTA) for Pharmacy Medical Management will effectively support the successful implementation and execution of all Medical Management pharmacy programs and processes. The Sr. Care Team Associate will provide support to the Medical Management pharmacy staff to ensure applicable program processes and operational responsibilities are met. The CTA will prepare Part B medication prior authorization requests for clinical review and will complete prior authorization requests and issue review outcome notifications to providers and members. This position will also provide support in troubleshooting any medication related issues identified by the Medical Management pharmacy staff. This position will also assist with training and orientation of new staff and will serve as a subject matter expert for existing staff to ask questions.
Location: 195000 West Interstate, San Antonio, TX 78257
Training: 8 weeks - M-F 8am - 5:30pm CST - ALL ONSITE
Work Schedule: M-F 8hr shift between 9am - 7pm CST w/1 hour lunch along with rotational Saturday shifts (every 8th Saturday); 6 days in office, other days will be remote with more in-office days required based on business needs
If you reside near San Antonio, TX you will enjoy the flexibility of a hybrid-remote role as you take on some tough challenges.
Primary Responsibilities:
Receives and responds to inquiries from all communication venues: e.g. phone, queue, department e-mail box or fax
Acts as a provider help desk specialist to aid providers in submitting prior authorization requests and communicating prior authorization request status
Coordinates and assists initial screening of prior authorization requests via all communication venues; as well as administrative preparation for clinical staff
Exhibits excellent phone and communication skills while providing complete and accurate information to customers
Requests additional or supplemental information via correspondence in order to complete prior authorization requests
Completes prior authorizations related to medications in the WellMed prior authorization system according to approved policies and procedures
Issues oral and written prior authorization outcome notifications to providers and members that comply with standards and requirements for timeliness, content, and accuracy
Triages and resolves claims-related issues related to specialty drugs requiring prior authorization
Requests additional review by clinical staff as needed
Compiles and reports data for ongoing key performance indicators and summarizes and presents findings to departmental leadership
Notifies manager of trends they observe
Adheres to assigned schedule and quality metrics
Provides clerical and/or administrative support to clinical staff and managers for special studies, projects and reports
Provides excellent customer service by serving as a resource to all internal and external customers
Attends required meetings and participates in special committees as needed
Assists with training and onboarding of Medical Management Pharmacy Care Team Associates
May act as a team lead for ad hoc projects and departmental initiatives as assigned
Performs other duties as assigned
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 experience in a medical or pharmacy setting
2+ years of administrative support experience
1+ years of medical terminology knowledge base
1+ years of general knowledge of CPT, HCPCS, and ICD-10
1+ years of working knowledge of Microsoft Office, Internet and e-mail
Ability to work 8-hour shift M-F between 9am - 7pm CST w/1 hour lunch along with rotational Saturday shifts (every 8th Saturday)
Ability to work at least 6 days in office per month with more based on business needs
Preferred Qualifications:
Certified Pharmacy Technician (CPhT) or Certified Medical Assistant training or certification
2+ years of experience with prior authorization or claims
Knowledge of specialty pharmaceuticals
Bilingual language proficiency (English/Spanish)
Soft Skills:
Able to work independently, with some supervision and direction from manager
Excellent organizational skills, customer service skills, and verbal and written communication skills to include but not limited to patients, physicians, clinical staff, contracted providers and managers
*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.
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: UnitedHealth Group 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.
UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
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