Prior Authorization Pharmacist - Remote in Vermont

Company: Optum
Location: Burlington
Posted on: November 19, 2024

Job Description:

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 diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.
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The essential functions of a Pharmacist in Prior Authorization are reviewing Prior Authorization cases and rendering coverage determinations based on clinical criteria and plan design in a fast-paced environment. This is a dynamic work setting and requires flexibility to meet business needs and adaptability to frequent changes.
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This position is for a Clinical Pharmacist working in the Prior Authorization department of OptumRx, a UnitedHealth Group company. This is a call center-based business segment and strict work guidelines are employed.
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If you are located in the state of Vermont, you will have the flexibility to work remotely* as you take on some tough challenges.
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Primary Responsibilities: -

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• Work is computer based, and is comprised of gathering complex clinical information, coverage policy and criteria information while working within regulatory guidelines to make coverage determinations
  
• Maintain minimum productivity and quality targets as dictated by the department's internal performance matrix
  
• Have solid attention to detail, organize workload, sets priorities, complete assignments in a timely manner and utilizes resources appropriately while complying with department program standards
  
• Certain job functions may include receiving phone calls from prior authorization pharmacy technicians and/or providers for clinical information, and consulting physicians/providers with questions
  
• Perform all duties and functions in compliance with state and federal pharmacy laws and regulations
  
• Dedication to build rapport and maintain productive working relationships with coworkers, management, internal customers, and other departments by demonstrating a solid customer service orientation and a continuous positive image of OptumRx
  
• Patient Safety and Quality of work is paramount and it's important for employees to have a safe and secure workspace and communicate with their leadership when that safety (equipment, system, information) is compromised
  
• Performs other duties and responsibilities as assigned by management
  
• Didactic training is 4 weeks, followed by additional on the job training. Training time is 8:00am-5:00pm local time, Monday- Friday. This training time is subject to change
  
• Shift after training is an 8-hour shift with a 30-minute lunch, unless dictated otherwise by law. Candidate must be available as early as 7:00 am and as late as midnight, however the usual shift is 10:30am-7:00pm local time
  
• Candidate will work 5 days a week, with the possibility of a weekend shift every 4 weeks
  
• There may be pre-scheduled overtime and/or working on holidays dependent on business needs
  
• Candidate must have access to internet that can hard wired with Ethernet cord. A business internet line will be provided upon onboarding
  
• Candidate must also have a secure office/workspace in their home
  
• Candidate must have some technical savvy when it comes to working with PC (ex. initial setup of equipment, accessing and navigating through multiple systems and screens)
  
• Candidate should have certain soft skills such as: sitting, use of hands/fingers across keyboard or mouse, long periods working at a computer, and listening using a headset
  
• Excellent attendance is a must throughout training and thereafter -
  
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  What are the reasons to consider working for UnitedHealth Group? - Put it all together - competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:
  
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  • Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays + Floating Holiday
    
  • Medical Plan options along with participation in a Health Spending Account or a Health Saving account
    
  • Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage
    
  • 401(k) Savings Plan, Employee Stock Purchase Plan
    
  • Education Reimbursement
    
  • Employee Discounts
    
  • Employee Assistance Program
    
  • Employee Referral Bonus Program
    
  • Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)
    
  • More information can be downloaded at:
    
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    You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.Required Qualifications: -
    
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    • Pharm.D. degree or Bachelor's degree in Pharmacy
      
    • Active and unrestricted Pharmacist license in good standing in the state of Vermont
      
    • Proven solid drug product and clinical pharmacy knowledge
      
    • Demonstrated ability to work independently with minimal supervision
      
    • Proven solid clinical ability to interpret criteria and implement clinical programs for prior authorization
      
    • Proven computer and typing proficiency, including with Microsoft Excel (ability to create, edit, and save a basic spreadsheet), Microsoft Word (ability to create, edit, and save a basic document), and Microsoft Outlook (ability to send emails), and SharePoint
      
    • Primary residence in the state of Vermont
      
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      Preferred Qualifications: -
      
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      • 1+ years of experience working as clinical pharmacist
        
      • Experience working in Prior Authorization
        
      • Experience working within a managed healthcare system -
        
      • Proven working knowledge of Medicare Part D, CMS regulations, NCQA, and State regulations
        
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        *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
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        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.
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        Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and 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.
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        UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

Keywords: Optum, Portland , Prior Authorization Pharmacist - Remote in Vermont, Healthcare , Burlington, Maine