If you want to achieve more in your mission of health care, you have to be really smart about the business of health care. Challenge yourself, your peers and our industry by shaping what health care looks like and doing YOUR LIFE'S BEST WORK.(SM)

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

The Prior Authorization Governance and Auditing Group provides audit and regulatory support related to Prior Authorization and Appeals for all clients of OptumRx.  The analyst(s) will serve as the performance guarantee (PG) subject matter expert during oversight and delegation audits performed by various clients.  Analyst(s) will be responsible to analyze and report OOC data, perform clinical review on all DOI inquiries to ensure the PA and appeal process are aligned with regulatory guidance.   Analyst(s) will lead data validation efforts for PA and Appeals including quality control for adherence to contractual agreements surrounding processing turnaround times and program requirements.  Clinical validation includes review of prior authorization cases for clinical decision-making based on individual plan formulary and requirement and patient demographics. The analyst(s) will ensure compliance to various regulations based on lines of business and plan design.  In addition to audit support, the analyst(s) will be involved with trending to identify process improvements to ensure compliance with applicable state and federal laws, business contract requirements, prevent untimely cases and maintain client relations.

PRIMARY RESPONSIBILITIES:

• End-to-end business process activities - creating, controlling and improving the Audit, Response Management, and Performance Guarantee processes related to Prior Authorization and Appeal
• Lead process design and project implementation teams to assure program compliance and quality control for adherence to audit requirements based on governing bodies
• Involved with trending to identify process improvements to ensure compliance with applicable state and federal laws, business contract requirements, prevent untimely cases and maintain client relations
• Analyzes and investigates root cause of non-compliant cases

DAILY PRACTICES:

• Advanced communication skills, including the ability to write, speak, and facilitate meetings at an advanced level

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 or GED
• 1 year of prior authorization related experience
• 1 year of experience analyzing data for trends
• 1 year demonstrated process improvement, workflow, benchmarking and/or evaluation of business processes experience
• 1 years of experience at an intermediate level of proficiency with Microsoft Suite; Word, Excel, PowerPoint and Visio
• If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or a similar UnitedHealth Group-approved symptom screener. When in a UnitedHealth Group building, employees are required to wear a mask in common areas, In addition, employees must comply with any state and local masking orders.

PREFERRED QUALIFICATIONS:

• Previous project management skills
• Pharmacy Technician license

CAREERS WITH OPTUM. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do YOUR LIFE'S BEST WORK.(SM)

You can learn more about all we are doing to fight COVID-19 and support impacted communities: click here.  

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy. 

COLORADO RESIDENTS ONLY: The hourly range for Colorado residents is $20.77 to $36.88. Pay is based on several factors including but not limited to education, work experience, certifications, etc. As 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 workplace. Candidates are required to pass a drug test before beginning employment.   _

Job Keywords: Business Process Analyst, Schaumburg, IL, Illinois, Telecommute, Remote, Work from Home, WFH, work at home, WAH, #RPO, Pharmacy Technician, Prior Authorizations, analyst, process improvement, project management, performance guarantee, hiring immediately

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