Pharmacy Care Coordinator

1 week ago


Texas City, Texas, United States Optum Full time
Optum Pharmacy Care Coordinator Job Description

At Optum, we're dedicated to delivering care and improving health outcomes for millions of people worldwide. As a Pharmacy Care Coordinator, you'll play a vital role in connecting patients with the care, pharmacy benefits, and resources they need to thrive.

Key Responsibilities:

  • Conduct outbound calls to members to discuss medication adherence and quality metrics
  • Gather prescription refill orders and provide excellent customer service
  • Determine member eligibility for the Medical Assistance Program
  • Participate in pharmacy quality improvement initiatives
  • Collect and maintain eligibility information in a confidential manner
  • Enter applications within specified timeframes to ensure eligibility deadlines are met

Requirements:

  • High School Diploma/GED (or higher)
  • 1+ years of experience in customer service
  • 6+ months of experience with Medicare Part D, particularly pharmacy record review, claims, billing, and reimbursement rules
  • 6+ months of experience with HIPAA Privacy and Security Rules and CMS security requirements
  • 6+ months of call center experience
  • Basic proficiency with Microsoft Office, Internet, and email

Preferred Qualifications:

  • Bilingual (English/Spanish)
  • PBM experience
  • Advanced knowledge of NCPDP and other prescription drug claims
  • Working knowledge of Medicare Part B and Part D coverage guidelines and payment methodologies

At Optum, we're committed to creating a healthier atmosphere by fostering diversity and inclusion. We're an Equal Employment Opportunity/Affirmative Action employer and welcome applicants from all backgrounds.



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