Senior Pharmacy Care Coordinator - Remote - West Region

Requisition Number: 2350045
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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale.Join us to start Caring. Connecting. Growing together.
Hours/Location: Must reside in Pacific or Mountain Time Zone. Variable hours to work 8-hours within the hours of 8:30 AM - 6:00 PM Pacific Standard Time Monday - Saturday based on business needs. You'll enjoy the flexibility to work remotely * from anywhere within Pacific or Mountain Standard Time Zones in the U.S. as you take on some tough challenges.
Primary Responsibilities:

• Rebate Management: This position oversees the comprehensive rebate process, encompassing claim analysis, attestation, preferred communication methods, claim submission, and audit coordination. Support the full rebate data engineering lifecycle including research, proof of concepts, design, development, testing, deployment, and maintenance of rebate data management solutions. The role is charged with implementing industry's best practices, minimizing operational risks, and promoting ongoing improvements in efficiency throughout all rebate-related activities
• Data and Trend Management:
  • Perform as an individual contributor by querying a variety of data sources, wrangling data, and building visually appealing dashboards and reports to identify insights and opportunities
  • Analyze, review, forecast, and trend complex rebate data to support enterprise-level decision making
  • Build and maintain complex rebate models, calculators, templates, and simulations to support forecasting, planning, and scenario analysis
  • Ensure timely and accurate delivery of consolidated rebate claims that serves as the single source of truth for rebate collection projection, tracking, payment reconciliation and other rebate program performance metrics
• Medication Access: Support access to medications by evaluating benefit options following UM (utilization management) determinations, including coverage denials or redirections. The role involves structured investigations to determine coverage under both medical and pharmacy benefits according to payer guidelines and plan requirements. Key tasks include confirming patient insurance eligibility and evaluating coverage standards across different benefits. This process may require examining prior authorization requirements, formulary placement, site-of-care policies, and potential patient cost implications
• Care Coordination: Work closely with physicians, advanced practice providers, nurses, pharmacists, and other healthcare professionals to promote coordinated care and effective medication management. The position requires proactive communication with other healthcare professional via phone, fax, and other electronic channels
• Cross-Functional Team Collaboration: Collaborate with various cross-functional teams to implement strategic projects that improve care delivery and network operations, ensuring compliance and maintaining high clinical standards. These teams span areas such as pharmacy management, utilization management, payment integrity, claims processing, health economics, finance, and contracting
• Compliance and Regulatory Requirements: Adhere to organizational policies related to affordability programs, patient confidentiality, and medication safety. Follows relevant regulatory guidelines, policies and procedures in reviewing clinical documentation (e.g., SOP's and Job Aids)
• Continuous Improvement: Engage in quality improvement activities and process enhancements aimed at increasing the efficiency and impact of affordability programs
• Additional Duties:
  • Anticipate leader needs by engaging in creative problem solving and ideation to bring new, relevant content to Operations
  • Work independently with minimal guidance while proactively escalating complex issues and risks
  • Applies a team approach to solving complex problems
  • Adapt team priorities to ensure task completion
  • Prepare medication utilization and prior authorization requests for specialty oncology and non-oncology ambulatory injectable and/or infusion medications as related to member benefits, health plan coverage, site of service, and evidence based clinical guidelines
  • Solves moderately complex problems and/or conducts moderately complex analyses and translates concepts into practice
  • Identifies incomplete/inconsistent information in medical records and label missing measures/metrics/concerns as well as evaluate documentation of prior authorization
  • Verifies necessary documentation is included in medical records
  • Develops learning objectives based on appropriate analyses (e.g., business analysis, task analysis, audience analysis)
  • Engages/collaborates with appropriate stakeholders, leaders and SMEs to complete appropriate training content (e.g., products, processes, tools, skills needed)
• Performs all other related duties as assigned

These efforts collectively promote clinical efficacy, cost-efficiency, and improved patient outcomes. Broad-based and comprehensive knowledge is critical to success in this role. You'll need to be well-versed in medical and pharmacy claims data.
You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:

• Associate's degree (or higher) in a health-related field, healthcare administration, data analytics, or a related discipline
• 3+ years of experience working with Excel, including XLOOKUP, complex formulas, Pivot Tables, charts, and graphs
• 2+ years of experience creating recurring and ad hoc reports, with comfort working with KPIs, trend analysis, and data validation
• 2+ years of experience in healthcare analytics, working with claims data and/or electronic health records (EHRs)
• 2+ years of experience building rebate analytical models and translating data into actionable business insights
• 2+ years of experience with working knowledge of medical terminology, including ICD-9, ICD-10, and CPT codes
• 2+ years of experience with working knowledge of HIPAA Privacy and Security Rules and CMS security requirements
• 2+ years of experience working collaboratively in multidisciplinary teams within a matrixed organization
• 2+ years of experience demonstrating strong written communication skills, with consistent delivery of accurate, error-free work
• 2+ years of experience performing work with minimal supervision, including in a remote work environment
• 1+ years of experience using SQL for ad hoc querying, analysis, and data reconciliation
• 1+ years of experience in data analytics with expert-level proficiency in Excel, including complex formulas, data modeling, and automation, as well as Power BI and/or Tableau for data visualization
• 1+ years of experience with extensive knowledge of Medicare Part B and Part D, including pharmacy record review, claims processing, billing, and reimbursement rules
• Intermediate (or higher) level of proficiency in Microsoft Office applications, including Outlook and Teams

Preferred Qualifications:

• Current clear and unrestricted Pharmacy Technician licensure in U.S. state of residence
• Certifications in Data Analytics, Project Management, LEAN/Six Sigma methodologies
• Intermediate (or higher) level of proficiency in SQL, Python, and/or R programming languages
• Experience in specialty infusion care delivery, inclusive of home infusion operations
• Excellent operation skills demonstrated by a significant record of performance (i.e., meeting or exceeding operational goals) in health care quality and cost management

*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $20.38 to $36.44 per hour based on full-time employment. We comply with all minimum wage laws as applicable.
Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
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