Job details
Job type full-time
Full job description
You’ll enjoy the flexibility to telecommute* from anywhere within the u.sAs you take on some tough challenges.
Welcome to one of the toughest and most fulfilling ways to help people, including yourselfWe offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancementJoin us and start doing your life`s best workSm
Providing outstanding service to our medicaid health plans takes a solid mix of business skills, technical proficiency, and industry knowledgeWe have a strong team of pharmacists and pharmacy service specialists and we are looking for a talented individual to join us as we grow our businessIn this position, our new team member will have the opportunity to develop an expertise in the medicaid, dsnp, and exchange business.
Training will be conducted virtually from your home.
*all telecommuters will be required to adhere to unitedhealth group’s telecommuter policy.
Primary responsibilities:
Act as outward-facing, dedicated resource for assigned accounts with direct client contact (not call center)
Build relationships with health plan, state partner, and internal contacts
Represent client internally and coordinate with other functions to implement client needs, complete projects, and address ongoing service needs
Coordination of problem resolution
Manage internal and external resources to promptly and effectively resolve problems or issues presented by health plans
Identify root cause of problems or issues and address with appropriate contacts to minimize and prevent future occurrencesSuch as: (a) review claims processing disagreement from provider, group or member(b) contact appropriate department for clarification and advice on necessary action for resolution(c) present problem to management for review or resolution as needed.
Positive interaction and communications with internal and external clients
Demonstrate proactive approach to servicing clients by assessing, anticipating, and delivering on their needs
Act as a member advocate resourceSupport member education by improving pharmacy-related health literacy with benefit navigation assistance
Assist with (a) member complaints, a&g (b) research member denials of prior auth requests – retrieves case notes, denial notices (c) pharmacy claim rejects – researching member or physician concerns by assisting pharmacies in claims adjudication and prescriber coordination (d) outreach to pbm optumrx for additional assistance if needed.
Resolve pharmacy issue such as: (a) cob (b) overrides placed for oon pharmacy (c) dmr’s
Assist plan pharmacy director with audits such as (a) state (b) ncqa (c) eqro (d) denial letters
Assist the plan pharmacy director with state/plan reporting needs such as (a) prior auth denial logs (b) lock-in reporting (c) hep c reporting
Expand provider educational efforts via individual and mass communication as negative trends are identified
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)
Healthcare / medical office experience
2+ years working within a pharmacy, pbm, or health plan
Preferred qualification:
Bachelor’s degree (or higher)
Familiarity with medication names and conditions
Proficient in microsoft word (sending and receiving information and creating documents) and microsoft excel (creating spreadsheets)
Customer service experience
Understanding rxclaim
Soft skill:
Good business phone skills
Telecommuting requirements:
Required to have a dedicated work area established that is separated from other living areas and provides information privacy
Ability to keep all company sensitive documents secure (if applicable)
Must live in a location that can receive a unitedhealth group approved high-speed internet connection or leverage an existing high-speed internet service
Unitedhealth group requires all new hires and employees to report their covid-19 vaccination status.
Military & veterans find your next mission : we know your background and experience is different and we like thatUnitedhealth group values the skills, experience and dedication that serving in the military demandsIn fact, many of the values defined in the service mirror what the unitedhealth group culture holds true: integrity, compassion, relationships, innovation and performanceWhether you are looking to transition from active duty to a civilian career, or are an experienced veteran or spouse, we want to help guide your career journeyLearn more at https://uhg.hr/transitioning-military
Learn how teresa, a senior quality analyst, works with military veterans and ensures they receive the best benefits and experience possibleHttps://uhg.hr/vet
Careers at unitedhealthcare medicare & retirementThe boomer generation is the fastest growing market segment in healthcareAnd we are the largest business in the nation dedicated to serving their unique health and well - being needsUp for the challenge of a lifetime? join a team of the best and the brightest to find bold new ways to proactively improve the health and quality of life of these 9 million customersYou`ll find a wealth of dynamic opportunities to grow and develop as we work together to heal and strengthen our healthcare systemReady? it`s time to do your life’s best workSm
Colorado residents only: the hourly range for colorado residents is $17.12 to $30.34Pay is based on several factors including but not limited to education, work experience, certifications, etcAs 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 workplaceCandidates are required to pass a drug test before beginning employment.
Keywords: uhg, healthcare, unitedhealth, pharmacy, pbm, rxclaim, work at home, work from home, wah, wfh, remote, telecommute, hiring immediately, #rpo
