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Pharmacy Care Coordination Associate

2 months ago

San Antonio, Texas, United States Optum Full time
Company Overview:

Optum is a worldwide leader in healthcare delivery, leveraging technology to enhance the well-being of millions. Our mission is to foster healthier lives through comprehensive care solutions.

Role Overview:

The -Pharmacy Care Coordination Associate- will engage in proactive outreach to members and healthcare providers to enhance medication adherence and optimize pharmacy-related quality metrics.

This role involves collecting prescription refill requests, delivering exceptional customer service, and assessing the eligibility of members for various assistance programs.


Work Schedule:
  • Monday to Friday, 9:00 AM to 6:00 PM CST, with rotating Saturdays from 8:00 AM to 5:00 PM CST

Key Responsibilities:
  • Conduct a high volume of outbound communications to members to address medication non-compliance, schedule pharmacy consultations, and gather essential follow-up data from providers.
  • Utilize an autodialer for outbound calls, requiring attention to detail and adaptability based on responses.
  • Handle inbound inquiries from members, directing calls to the appropriate departments as needed.
  • Follow established scripts and verify member demographic information accurately.
  • Document interactions with providers or members thoroughly and accurately.
  • Review claims documentation to ensure correct billing and validate payments to pharmacies.
  • Support internal teams and providers with Medicare-related inquiries.
  • Contribute to pharmacy quality improvement initiatives.
  • Maintain confidentiality while managing eligibility information.
  • Ensure timely entry of applications to meet eligibility deadlines.
  • Exhibit excellent communication skills while providing accurate information to members.
  • Request additional information via correspondence to complete applications.
  • Adhere to assigned schedules and quality performance metrics.
  • Utilize a multi-line phone system for inquiries regarding eligibility and medication refills.
  • Comply with all policies and procedures related to assistance programs.
  • Perform other related duties as assigned.
  • Demonstrate logical reasoning for problem-solving.

Why Consider Optum? We offer competitive compensation, a comprehensive benefits package, and a management team dedicated to your professional growth.

Benefits Include:
  • Accrued Paid Time Off and 8 Paid Holidays
  • Medical Plan options with Health Spending Accounts
  • Dental, Vision, Life & AD&D Insurance, Short-term and Long-term Disability coverage
  • 401(k) Savings Plan and Employee Stock Purchase Plan
  • Education Reimbursement and Employee Discounts
  • Employee Assistance Program and Referral Bonus Program
  • Voluntary Benefits

Required Qualifications:

  • High School Diploma/GED or higher
  • 1+ years of experience in customer service
  • 6+ months of experience with Medicare Part D, including pharmacy record review and claims
  • 6+ months of experience with HIPAA Privacy and Security Rules
  • 6+ months of call center experience
  • Basic proficiency in Microsoft Office and email
  • Ability to sit and stand for extended periods
  • Fine motor skills for operating office equipment
Preferred Qualifications:
  • Bilingual (English/Spanish)
  • Experience in Pharmacy Benefit Management (PBM)
  • Advanced knowledge of prescription drug claims
  • Familiarity with Medicare coverage guidelines
  • Previous retail pharmacy experience

At Optum, we are committed to fostering an inclusive environment that promotes health equity and addresses health disparities. We are an Equal Employment Opportunity/Affirmative Action employer, and all qualified applicants will receive consideration for employment without regard to any protected characteristic.