As one of the largest pharmacy benefits managers in the United States, UnitedHealth Group provides a professional culture where you're empowered and encouraged to exceed the expectations of our members, with better schedules than retail and more reach than any hospital. Join us and start doing your life's best work.(sm)
Positions in this function perform various duties related to the authorization process. Interprets physician's letters of medical necessity, inputs and retrieves information from computer system. Consults with peer technicians, pharmacists, physicians and/or other UHC departments regarding use of medications and policy requirements. Reviews and approves / pends requests for prescription prior authorizations. Knowledge of specialty medications. Positions in this function also perform various duties related to the fulfillment of prescription orders. Interprets physicians' prescriptions and creates order, accesses, inputs, and retrieves prescription information from computer system, verifies whether order is reimbursable. Processes prior authorization requests for any or all of the following: unit doses, specialty pharmaceuticals and infusible medications. Consults with peer technicians and / or pharmacists regarding use of medications and policy requirements. Reviews and approves / denies requests for prescription prior authorizations. Pharmacists must have a current license without restrictions and Pharmacy Technicians must have current state license or national certification without restrictions based on regulatory requirements of work site.
Review team stats and provide supervisor with feedback on individual and team progress.
Apply knowledge / skills to complex activities
Remain available to staff to answer questions directly in - person or via telephone or email or instant message
Ensure staff is clearly informed of all procedures and updates i.e. ad hoc training, education, process updates, etc.
Make recommendations on efficiencies, improvements, or enhancements to existing work flow and process
Other duties / projects as assigned
Work in production
Assist regional personnel (directors, pharmacists, and technicians) and respond to requests via email, IM, or phone.
Take escalated and/or supervisor calls
Providing initial coaching to staff, as needed.
Extensive work experience, possibly in multiple functions.
Work does not usually require established procedures.
UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.
We are committed to introducing innovative approaches, products and services that can improve personal health and promote healthier populations in local communities. Our core capabilities... in clinical care resources, information and technology uniquely enable us to meet the evolving needs of a changing health care environment as millions more Americans enter a structured system of health benefits and we help build a stronger, higher quality health system that is sustainable for the long term.
We serve our clients and consumers through two distinct platforms:
?UnitedHealthcare, which provides health care coverage and benefits services.
?Optum, which provides information and technology-enabled health services.