Pharmacist PA/Appeals

Realistic Job Preview Video 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. The essential functions of a Senior Pharmacy PA/Appeals Technician are providing expertise and customer service support to members, customers, and/or providers. This position exists to take incoming requests for prior authorizations, for formulary and non-formulary medications, while ensuring a high level of customer service and maximizing productivity. Requests can be received via fax or telephone, from providers' offices and pharmacists. The position provides clinical review for authorizations in keeping with legal and contractual requirements, including but not limited to turn around times (TATs) and service level agreements (SLAs). The technician must provide the information clearly, accurately and in a professional manner. Interactions with callers must be documented per contractual and various regulatory / legal requirements.

Schedule: Ability to work any shift from 7:00 AM to 7:00 PM timeframe with flexible hours, including OT If you reside within the states of Wyoming, you will enjoy the flexibility to telecommute* as you take on some tough challenges.

Work is computer based, and is comprised of gathering complex clinical information, coverage policy and criteria information while working within regulatory guidelines to make coverage determinations Maintain minimum productivity and quality targets as dictated by the department's internal performance matrix Have solid attention to detail, organize workload, set priorities, complete assignments in a timely manner and utilize resources appropriately while complying with department program standards Certain job functions may include receiving phone calls from prior authorization pharmacy technicians and/or providers for clinical information, and consulting physicians/providers with questions Perform all duties and functions in compliance with state and federal pharmacy laws and regulations Dedication to build rapport and maintain productive working relationships with coworkers, management, internal customers, and other departments by demonstrating a solid customer service orientation and a continuous positive image of OptumRx Patient Safety and Quality of work 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 Performs other duties and responsibilities as assigned by management Didactic training is 4 weeks, followed by additional on the job training Shift after training is an 8-hour shift with a 30-minute lunch, unless dictated otherwise by law. Candidate must be available as early as 7:00 am and as late as 7:00pm local time Candidate will work 5 days a week There may be pre-scheduled overtime and/or working on holidays dependent on business needs Candidates must have access to internet that can hard wired with Ethernet cord. A business internet line will be provided upon onboarding Candidates must also have a secure office/workspace in their home Candidate must have some technical savvy when it comes to working with PC (ex. initial setup of equipment, accessing and navigating through multiple systems and screens) Candidate should have certain soft skills such as sitting, using hands/fingers across keyboard or mouse, long periods working at a computer, and listening using a headset Excellent