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Positions in this function consult with customers, members, patients, providers, internal departments and / or external third parties on any or all of the following: - Consult with and coordinate initial set up and on - going treatment plan for specialty drug patients, including DURs, co - pay assistance, ancillary products, scheduling Pharmacist consults and / or RN visits, and liaison with provider offices on labs, refill orders and prior authorizations.
- Promptly and accurately does benefits investigations
- Highlights any important notes / requests from the provider in the case
- Prioritizes and organizes cases to be processed in timely manner proportionate with the need by date
- Accurately enters orders into the pharmacy system
- Verifies validity of prescriptions and documents verification per company procedures
- Contacts the physician's office to communicate clinical information when needed
- Notifies pharmacist of relevant clinical information gathered during calls to provider or patient that may affect the patient's decease state or medication regimen
- Verifies secondary insurance with each prescription that requires billing a secondary plan
- Forwards cases to Financial Assistance Team if financial assistance is needed
- Notify Pharmacist to transfer prescriptions that can no longer be filled at AOS / Avella to appropriate pharmacy along with notifying the provider and the patient. Follow up with transfer until a resolution is reached
- Works with physician offices to facilitate the process of obtaining prior authorization from third party payers in order to maximize patient's access to treatment
- Monitors, follows up with and records all pending insurance prior authorizations to expedite processing time
- Contacts patients to arrange delivery of medication; verifies delivery address and collect payment information
- Offers the patient a consultation from a pharmacist
- Answers telephones and takes messages for patient refill requests and related pharmacy business
- Checks voicemails on assigned days
- Reports all customer complaints to a supervisor and allows the supervisor to rectify the situation with the complainant
- Helps to maintain the pharmacy in a clean and orderly condition
- Provides excellent customer service to all patients and medical professionals via phone, written communication or in person
- Maintains a collaborative approach with members of the Avella team
- Demonstrates the utmost sensitivity and confidentiality of information while maintaining a high level of professionalism
- Assumes additional projects on an as needed basis
- Direct working relationship with Store Manager, Pharmacist in Charge, Director of Pharmacy Operations and Director of Patient Financial Assistance
- Review and advise on medications and treatment plans (based on review of medical case notes, medication list and lab results) to improve outcomes and avoid potential drug interactions
- Discuss with patients life issues affecting medication adherence and provide advice on improving drug regimen compliance
- Advise patients on alternate Rx fill strategies of retail versus mail order and options for financial assistance.
- May outreach to providers on suspected medication abuse situations.
- Review medication regimen for disease state for LTC facilities / hospice care / RN case managers / Medical Directors / clients and provide summaries and guidance on future medication plans. Advice may include alternate drug therapies, stopping a medication and / or lower cost alternative.
- Review medical case notes to determine on - going medication treatment plan and project future medication costs.
- Moderate work experience within own function.
- Some work is completed without established procedures.
- Basic tasks are completed without review by others.
- Supervision / guidance is required for higher level tasks.
- High School Diploma / GED (or higher)
- 6 months of customer service experience
- Availability for an 8 - hour shift between 6:00 am - 6:00 pm Monday through Friday, rotating Saturdays
- Proficiency with computer and Windows PC applications including ability to navigate and learn new and complex computer system application
- Pharmacy Technician licensing and registration in Arizona
- National Pharmacy Technician Certification
- 1+ years of pharmacy related experience (includes retail pharmacy experience)
- Bilingual a plus
OptumRx is an empowering place for people with the flexibility to help create change. Innovation is part of the job description. And passion for improving the lives of our customers is a motivating factor in everything we do.
If you're ready to talk about groundbreaking interactions,
let's talk about what happens when a firm that touches millions of lives
decides to gather results from millions of prescriptions every month and
analyze their impact. Let's talk about smart, motivated teams. Let's talk about
more effective and affordable healthcare solutions. This is caring. This is
great chemistry. This is the way to make a difference. We're doing all this,
and more, through a greater dedication to our shared values of integrity,
compassion, relationships, innovation and performance. Join us and start doing 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.
Keywords: Pharmacy, Customer Service, Coordinator, UHG, OptumRX