Pharmacy Care Team Associate

Careers at UnitedHealth Group

We're creating opportunities in every corner of the health care marketplace to improve lives while we're building careers. At UnitedHealth Group, we support you with the latest tools, advanced training and the combined strength of high caliber co-workers who share your passion, your energy and your commitment to quality. Join us and start doing your life's best work. SM

Clinical

Compassion. It's the starting point for health care providers like you and it's what drives us every day as we put our exceptional skills together with a real feeling of caring for others. This is a place where your impact goes beyond providing care one patient at a time. Because here, every day, you're also providing leadership and contributing in ways that can affect millions for years to come. Ready for a new path? Learn more, and start doing your life's best work. SM

Our teams are helping people from around the world. We can bring out your best as you put your listening, analytical and problem solving skills to work in a setting that is geared to helping improve lives and enhance health care for millions. Here, you'll discover a wealth of pathways for professional growth within Customer Service, Billing, Claims, Enrollment & Eligibility and across our global economy. Join us and find out why this is the place to do your life's best work. SM

Do you have compassion and a passion to help others? Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieve your life's best work.(sm)

The Senior Care Team Associate (CTA) for Pharmacy Medical Management will effectively support the successful implementation and execution of all Medical Management pharmacy programs and processes. The Sr. Care Team Associate will provide support to the Medical Management pharmacy staff to ensure applicable program processes and operational responsibilities are met. The CTA will prepare Part B medication prior authorization requests for clinical review and will complete prior authorization requests and issue review outcome notifications to providers and members. This position will also provide support in troubleshooting any medication related issues identified by the Medical Management pharmacy staff. This position will also assist with training and orientation of new staff and will serve as a subject matter expert for existing staff to ask questions.

Primary Responsibilities:
  • Receives and responds to inquiries from all communication venues: e.g. phone, queue, department e-mail box or fax
  • Acts as a provider help desk specialist to aid providers in submitting prior authorization requests and communicating prior authorization request status
  • Coordinates and assists initial screening of prior authorization requests via all communication venues; as well as administrative preparation for clinical staff
  • Exhibits excellent phone and communication skills while providing complete and accurate information to customers
  • Requests additional or supplemental information via correspondence in order to complete prior authorization requests
  • Completes prior authorizations related to medications in the WellMed prior authorization system according to approved policies and procedures
  • Issues oral and written prior authorization outcome notifications to providers and members that comply with standards and requirements for timeliness, content, and accuracy
  • Triages and resolves claims-related issues related to specialty drugs requiring prior authorization
  • Requests additional review by clinical staff as needed
  • Compiles and reports data for ongoing key performance indicators and summarizes and presents findings to departmental leadership
  • Notifies manager of trends they observe
  • Adheres to assigned schedule and quality metrics
  • Provides clerical and/or administrative support to clinical staff and managers for special studies, projects and reports
  • Provides excellent customer service by serving as a resource to all internal and external customers
  • Attends required meetings and participates in special committees as needed
  • Assists with training and onboarding of Medical Management Pharmacy Care Team Associates
  • May act as a team lead for ad hoc projects and departmental initiatives as assigned
  • Performs other duties as assigned


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 or GED
  • 4+ years of experience in a medical or pharmacy setting
  • 2+ years of administrative support experience
  • Medical terminology knowledge base
  • General knowledge of CPT, HCPCS, and ICD-10
  • Working knowledge of Microsoft Office, Internet and e-mail


Preferred Qualifications:
  • Certified Pharmacy Technician (CPhT) or Certified Medical Assistant training or certification
  • 2+ years of experience with prior authorization or claims
  • Knowledge of specialty pharmaceuticals
  • Bilingual language proficiency (English/Spanish)
  • Able to work independently, with some supervision and direction from manager
  • Excellent organizational skills, customer service skills, and verbal and written communication skills to include but not limited to patients, physicians, clinical staff, contracted providers and managers


Careers with WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors., WellMed is a network of doctors, specialists and other medical professionals that specialize in providing care for 550,000+ older adults with over 16,000 doctors' offices in Texas and Florida through primary and multi-specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team and a singular opportunity to do your life's best work.(sm)

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.

Job Keywords: Medicare Part B, IV Drugs, Prior Authorization, clinical review, pharmacy, specialty pharmacy, San Antonio, TX, Texas

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