Employment Type: Full-Time
Loading some great jobs for you...
Energize your career with one of Healthcare's fastest growing companies.
You dream of a great career with a great company - where you can make an impact and help people. We dream of giving you the opportunity to do just this. And with the incredible growth of our business, it's a dream that definitely can come true. Already one of the world's leading healthcare companies, UNITEDHEALTH GROUP is restlessly pursuing new ways to operate our service centers, improve our service levels and help people lead healthier lives. We live for the opportunity to make a difference and right now, we are living it up.
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. At Optum, a growing part of our family of companies that make UnitedHealth Group a Fortune 6 leader, you'll find better schedules than retail and more reach than any hospital. You'll open doors for yourself that simply do not exist in any other organization, anywhere. Take this opportunity to start doing YOUR LIFE'S BEST WORK.(SM)
***MULTIPLE POSITIONS AVAILABLE AT THIS TIME***
Optum Puerto Rico Operations is creating an innovative approach to Pharmacy Benefit Management. As a PHARMACIST - PRIOR AUTHORIZATION, you will work in a corporate call center based business environment where strict work guidelines are employed. As a Pharmacist - Prior Authorization, you will be responsible for evaluating Prior Authorization cases and rendering coverage determinations based on clinical criteria and plan design in a fast paced and dynamic environment.
- Work in computer based and includes receiving phone calls from prior authorization pharmacy technicians and/or providers for clinical information
- Consult physicians/providers with questions, interpret clinical guideline criteria, and render/review coverage determination for prior authorization cases
- Consult with pharmacy technicians and/or physicians regarding use of medications and advise of appropriate formulary alternatives when requested
- Gather complex clinical information, coverage policy and criteria information and work within regulatory guidelines to make coverage determinations
- Organize workload, sets priorities, completes assignments in a timely manner and utilizes resources appropriately while complying with department program standards
- Perform all duties and functions in compliance with state and federal pharmacy laws and regulations
- Conform with and supports department quality assurance and improvement guidelines
- Dedication to build rapport with coworkers, internal customers, and other departments by demonstrating a strong customer service orientation and a continuous positive image of OptumRx
- Demonstrate ability to maintain productive working relationships with team members, other internal and external customers, and management team
*** ENGLISH PROFICIENCY ASSESSMENT WILL BE REQUIRED AFTER APPLICATION ***
This position is full-time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8 hour shift schedules during our normal business hours of 10:30am - 7:30pm AST. It may be necessary, given the business need, to work occasional overtime or weekends. Our office is located in the Montehiedra area in San Juan.
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.
Loading some great jobs for you...