Job Description

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)

Welcome to one of the toughest and most fulfilling ways to help people, including yourself. Under (virtual) supervision of a Registered Pharmacist/Nurse, triage of all medical and specialty drug preauthorization requests, including prioritization of reviews, case preparation, documentation tracking and organization, case review and, where appropriate, coordinate escalation for clinical review. Join us and start doing your life's best work. (sm)

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

Primary Responsibilities:

* Perform Prior Authorization case reviews for medical injectables/infusions under (virtual) supervision of a Registered Pharmacist/Nurse, including prioritization of reviews, verifying Prior Authorization requirements, demonstration of compliance with URAC , groups requirements and turn-around time where appropriate, Non-Clinical case review using Job Aids, SOPs, and group nuances guidelines, coordinate escalation for clinical review.
* Non-Clinical pre-service review includes eligibility verification, benefit interpretation, type of case review verification, requesting clinical information when necessary, requesting clarification when appropriate, identifying plan exclusions, preparing cases for clinical review using appropriate plan benefit language, utilizing appropriate templates, generating letters and provide clear, concise verbal feedback to physician(s), specialty pharmacy vendor(s), and member(s) as required.
* Pharmacy Technicians are able to approve injectable medications in certain situations that do not require clinical judgment or interpretation of clinical information.

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you a 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
* Valid and active Pharmacy Technician License in any state (or willingness to obtain within 9 months of hire)
* Intermediate proficiency or better with Windows PC applications
* 1+ years of experience with Prior Authorization
* 1 + years of experience with ICD9/ICD10, J codes, or other drug and drug administration related CPT and HCPC Codes
* 1+ years of experience working with drugs and drug classes
* If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or similar UnitedHealth Group-approved symptom screener. When in a UnitedHealth Group building, employees are required to wear a mask in common areas. In addition, employees must comply with any state and local masking orders

Preferred Qualifications:

* PTCB (must be able to become certified within first 9 months of being hired)

Competencies and Best Practice for High Performers:

* Excellent Customer Service Skills
* Excellent Clerical Skills
* Excellent Business Communication skills, orally and written
* Assess and interpret customer needs and requirements
* Problem solver
* Generally work is self-directed and not prescribed
* Works with minimal guidance; seeks guidance as needed
* Works well in a changing environment
* Works with less structured, more complex issues
* Accountable for work and deadlines

UnitedHealth Group is an essential business. The health and safety of our team members is our highest priority, so we are taking a science driven approach to slowly welcome and transition some of our workforce back to the office with many safety protocols in place. We continue to monitor and assess before we confirm the return of each wave, paying specific attention to geography-specific trends. At this time, 90% of our non-clinical workforce transitioned to a work at home (remote) status. We have taken steps to ensure the safety of our 325,000 team members and their families, providing them with resources and support as they continue to serve the members, patients and customers who depend on us.

Some of the steps we've taken to ensure employee well-being include:

* Transitioned our new hire training classes to be conducted virtually
* Launched our ProtectWell app and UnitedCARES program to help ease the burden and stress for our UnitedHealth Group team members and their immediate family affected by COVID-19
* Daily updates from our CEO Dave Wichmann to support and inspire team members during this challenging time
* Onsite social distancing and increased sanitization measures for employees who have been welcomed back to our offices
* Fully cover the COVID-19 healthcare costs for our employees
* Employees who self-identify as high risk or who live with someone who is high risk have been asked to remain working from home

You can learn more about all we are doing to fight COVID-19 and support impacted communities at: click here.

What we do defines who we are. Take a deeper look at how we're providing support during this global health crisis and search for a way you can get involved. View our COVID-19 Resources Page: click here.

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

Colorado Residents Only: The hourly range for Colorado residents is $15.00 to $25.19. Pay is based on several factors including but not limited to education, work experience, certifications, etc. As of the date of this posting, In addition to your salary, UHG offers the following benefits for this position, subject to applicable eligibility requirements: Health, dental, and vision plans; wellness program; flexible spending accounts; paid parking or public transportation costs; 401(k) retirement plan; employee stock purchase plan; life insurance, short-term disability insurance, and long-term disability insurance; business travel accident insurance; Employee Assistance Program; PTO; and employee-paid critical illness and accident insurance.

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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