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.

Positions in this function prep, review and approve/deny requests for prescription prior authorization and/or appeal. Clerks scan, index and prepare documents related to prior authorization and/or appeal request, verifying and updating patient/member profile information. Techs and Pharmacists compile medical notes (disease state, drug treatment history and current drug plan) from patient/provider in support of the request, review request against decision tree and approval protocol, perform outreach for additional information as needed to support the request. Update approved requests in claims systems and inform patient/provider of approval. Forward applicable requests through additional review path as needed. Ensures Rx denial is communicated to patient/provider along with rationale.

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Extensive work experience, possibly in multiple functions

• Work does not usually require established procedures

• Works independently

• Mentors others

• Acts as a resource for others

• Coordinates others' activities

• Requires current pharmacy technician state license or national certification without restrictions based on regulatory requirements of worksite

• Assist with the coordination, supervision and be accountable for the daily/weekly/monthly activities of team members

• Engage team and ensure task completion and performance goals are met, such as: Quality, Adherence, Service Level and AHT

• Coordinate work activities with other supervisors, managers, departments, etc

• Identify and resolve operational problems using defined processes, expertise and judgment

• Provide coaching and feedback to team members, including formal corrective action

• Provide expertise and customer service support to members, customers, and/or providers

• Lead, assist and be accountable for professional employees and/or supervisors

• Safety 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

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:

• High School Diploma/GED (or higher)

• Active National or State Board Pharmacy Technician Licensure OR Pharmacy Technicians Certification Board (PTCB) or ability to obtain prior to hire

• 2+ years of Customer Relations experience

• 1+ years of operations experience

• Intermediate level of proficiency 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)

• Able to work 7am to 7pm with ability to work flexible hours, including OT and weekends

Preferred Qualifications:

• ExCPT – Pharmacy Technician Certification with National Healthcareer Association (NHA)

• The National Board of Prior Authorization Specialist

• Experience leading personnel towards the attainment of exceptional performance results

• Knowledge of Call Center systems such as CMS, IEX, CTI and TCS preferred

• Understanding of call center performance metrics and measurements

Soft Skills:

• Strong communication skills, both written and oral

• Ability to hold team accountable and support their Supervisor and the leadership team

• Ability to follow through on tasks

• Needs to be able to strategize and understand business structure

• Strong time management and attention to detail

Physical Requirements and Work Environment:

• Frequent speaking, listening using a headset, sitting, use of hands/fingers across keyboard or mouse, handling other objects, long periods working at a computer

• Ability to have their own home internet access/VPN (internet can be hard wired with Ethernet cord)

• Have a secure work space/office in their home

• Have level skill with working with PC (ex. using mouse and keyboard, accessing and navigating through multiple systems and screens)

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

California, Colorado, Nevada, Connecticut, New York, New Jersey, Rhode Island, Hawaii, Washington, or Washington D.C Residents Only : The hourly range for California, Colorado, Nevada, Connecticut, New York, New Jersey, Rhode Island, Hawaii, Washington, or Washington D.C residents is $19.47 to $38.08 per hour. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

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.

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.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

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