Pharmacy Care Associate Coordinator

1 week ago

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

Optum is a leading global organization dedicated to enhancing healthcare delivery through innovative technology, positively impacting the lives of millions.

Role Overview:

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

This role involves gathering prescription refill requests and delivering exceptional customer service while assessing the eligibility of members for the Medical Assistance Program.


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 calls to members to address medication non-compliance, schedule pharmacy consultations, and gather essential follow-up information from healthcare providers.
  • Utilize an autodialer for outbound calls, requiring attention to detail and adaptability to various responses.
  • Respond to inbound calls from members, assisting with inquiries and routing calls to the appropriate department as needed.
  • Follow established scripting and validate member demographic information during calls.
  • Document accurate information obtained during calls in the member or provider's record.
  • Review claims documentation to ensure correct billing and appropriate payments to contracted pharmacies.
  • Support internal staff, subcontractors, and providers regarding Medicare drug-related inquiries.
  • Contribute to pharmacy quality improvement initiatives.
  • Maintain eligibility information confidentially and accurately.
  • Enter applications within specified time frames to meet eligibility deadlines.
  • Exhibit excellent communication skills while providing complete and accurate information to members.
  • Request additional information via correspondence to complete applications.
  • Adhere to assigned schedules and quality metrics.
  • Utilize a multi-line phone system to handle calls regarding eligibility and medication refill requests.
  • Comply with all policies and procedures for the Medical Assistance Program.
  • Perform other related duties as assigned.
  • Receive and comprehend instructions effectively, both verbally and in writing.
  • Employ logical reasoning for problem-solving.

Why Work for Optum? Optum offers competitive base pay, a comprehensive benefits package, performance rewards, and a management team committed to your success.

Benefits Include:
  • Accrued Paid Time Off plus 8 Paid Holidays
  • Medical Plan options with Health Spending Account or Health Savings Account
  • 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 (pet insurance, legal insurance, etc.)

At Optum, we are dedicated to helping individuals lead healthier lives and improving the healthcare system for everyone. We are committed to addressing health disparities and enhancing health outcomes for all communities.

Diversity and Inclusion: Optum is an Equal Employment Opportunity / Affirmative Action employer. 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.

Optum maintains a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

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