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Positions in this function prep, review and approve/deny requests for prescription prior authorization and/or appeal. Clerks scan, index and prepare documents related to prior authorization and/or appeal request, verifying and updating patient/member profile information. Techs and Pharmacists compile medical notes (disease state, drug treatment history and current drug plan) from patient/provider in support of the request, review request against decision tree and approval protocol, perform outreach for additional information as needed to support the request. Update approved requests in claims systems and inform patient/provider of approval. Forward applicable requests through additional review path as needed. Ensures Rx denial is communicated to patient/provider along with rationale.
- Processes prior authorization requests for any or all of the following: unit doses, specialty pharmaceuticals and infusible medications
- Speak with Pharmacies, Providers, Members to obtain proper information for prior authorizations
- 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) or equivalent work experience
- Indiana Pharmacy Technician License
- National Pharm Tech Certification
- Proficiency with computer and Windows PC applications including ability to navigate and learn new and complex computer system application
- Ability to work Monday - Friday any 8 hour shift between the 8 a.m. - 8 p.m. with the ability to work an occasional weekend rotation
- Pharmacy / prescription data entry experience
- Previous Call Center Experience
- Previous Pharmacy Experience
- Previous experience with Prior Authorizations .
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: Certified Tech, Pharmacy Tech, Rx, Prior Authorization, PA, Appeals, Technician, Call Center, Data Entry, OptumRx