For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start **Caring. Connecting. Growing together.** Unique remote opportunity for an experienced healthcare employee to improve patient care and outcomes through assistance in preparation of utilization management reviews for value-based patients in the Optum West region. This is a full-time position with variable hours between 8:00 am to 6:00 pm PST, Monday – Friday (Five 8-hour days). Rotating weekend coverage. This position functions to support the Pharmacy Team and Pharmacy Operations Leadership. The Supervisor of Pharmacy Operations, coordinates, supervises and is accountable for the daily functions of the pharmacy Technicians & Coordinators &. Assist the department with business process and policy development of programs and productivity initiatives. Develops and analyzes monthly reports and a variety of ad hoc reports to support key departmental and corporate initiatives. Performs special projects as related to auditing and training. Coordinates internal and external data compilation for further standardization of process and training for the Pharmacy team. If you are located in the PST time zone, you will have the flexibility to work remotely* as you take on some tough challenges. **Primary Responsibilities:** + Applies a team approach to solve complex problems + Sets priorities for the team to ensure task completion + Serves as a primary point of contact and provides explanations for members, providers, and internal partners regarding processes, roles and responsibilities within their department + Prepare medication utilization and prior authorization requests for specialty oncology and non-oncology ambulatory injectable and/or infusion medications as related to member benefits, health plan coverage, site of service, and evidence based clinical guidelines + Solves moderately complex problems and/or conducts moderately complex analyses and translates concepts into practice + Provides explanations and information to others on difficult issues + Follows relevant regulatory guidelines, policies and procedures in reviewing clinical documentation (e.g., SOP’s and Job Aids) + Identifies incomplete/inconsistent information in medical records and label missing measures/metrics/concerns as well as evaluate documentation of prior authorization + Analyzes and prioritizes relevant data/reports and research (e.g., Pharmacy data, geographical trends, prior authorization data) + Coordinates auditing tasks as assigned + Reviews medical records for compliance with regulatory guidelines (e.g., NCQA, state Medicaid contracts, Clinical Practice Guidelines) + Verifies necessary documentation is included in medical records + Develops learning objectives based on appropriate analyses (e.g., business analysis, task analysis, audience analysis) + Engages/collaborates with appropriate stakeholders and SMEs to determine appropriate training content (e.g., products, processes, tools, skills needed) + Develop approach to evaluate achievement of learning objectives (e.g., learning assessments) + Identify and document resources needed to deliver training solutions (e.g., classroom resources, system resources, supplies) + Obtain stakeholder approval/sign-off of training designs + Develop tools/resources for evaluating/measuring post-training learning effectiveness (e.g., surveys, interviews, focus groups, observations checklists) + Performs all other related 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:** + 2+ years of experience in Utilization Management in a Pharmacy setting + 5+ years of related experience with at least two years in a supervisory capacity + Proven medical terminology, ICD-9/ICD-10 and CPT knowledge + Experienced working in metrics driven environment + Proven extensive knowledge of the Medicare Part B and Part D, particularly the pharmacy record review, claims, billing and reimbursement rules + Proven solid interpersonal skills and the ability to work independently, as well as a member of a team + Proven working knowledge of HIPAA Privacy and Security Rules and CMS security requirements + Proven working knowledge of Medicare Part B and Part D coverage guidelines and payment methodologies + Demonstrated general writing skills and ability to produce work free from typographical or spelling errors + Ability to perform work at the same time supervise a team + Ability to perform work with minimal supervision + Ability to delegate task appropriately to meet established timelines + Proficiency with Microsoft Office applications **Preferred Qualifications:** + Certified Pharmacy Technician (CPhT) OR Registered Nurse with a current license to practice in the state of employment + Experience with specialty pharmacy + Experience with Oncologic agents, Immunologic, or other specialty injectable *All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy The salary range for this role is $59,500 to $116,600 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives. _At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission._ _Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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._ _OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment._