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![Optum](https://media.trabajo.org/img/noimg.jpg)
Senior Pharmacy Care Coordinator
1 month ago
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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