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Senior Pharmacy Care Coordinator

1 month ago

Colorado Springs, United States Optum Full time

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. Hours:

Willing to work between the hours of 8am to 6pm Mountain or Pacific Standard time. This is a 40 hour a week position Monday through Friday. The schedule will be determined by the supervisor upon hire. You'll enjoy the flexibility to telecommute* from anywhere within the U.S. working in the MST or PST time zone 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 a higher level of review when indicated Prepares utilization reviews of professionally administered medications using InterQual/Milliman and 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 Documents and communicates in a professional and compliant manner within the appropriate electronic health record, by telephone or fax to support medication reviews, adherence, or other pharmacy care management initiatives 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 Makes appropriate care management referrals through triage process during care transition to case management staff 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 Required Qualifications: High School Diploma/GED (or higher) 3+ years of Pharmacy or Healthcare related experience 2+ years of experience in any of the following: a patient facing healthcare role, experience with Utilization Review, medical or pharmacy management for Insurance or Community Based facility Intermediate level of computer proficiency with Microsoft Office applications including Word, Excel, Teams, and Outlook) Be able to use multiple web applications at one time Ability to work between the hours of 8am to 6pm Mountain or Pacific Standard time Preferred Qualifications: Pharmacy Technician or MA license in good standing, in any state Advanced Education (i.e. Associate's or Bachelor's degree) CPhT certification Experience in managed care pharmacy (Pharmacy Benefits Manager, Medicare Advantage) Experience using EMR systems Knowledge of Medicare part B Knowledge of HIPAA

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