POSITION DESCRIPTION

Do you have compassion and a passion to help others? Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieve YOUR LIFE'S BEST WORK.(SM)

The SENIOR CARE TEAM ASSOCIATE (CTA) FOR PHARMACY MEDICAL MANAGEMENT will effectively support the successful implementation and execution of all Medical Management pharmacy programs and processes. The Sr. Care Team Associate will provide support to the Medical Management pharmacy staff to ensure applicable program processes and operational responsibilities are met. The CTA will prepare Part B medication prior authorization requests for clinical review and will complete prior authorization requests and issue review outcome notifications to providers and members. This position will also provide support in troubleshooting any medication related issues identified by the Medical Management pharmacy staff. This position will also assist with training and orientation of new staff and will serve as a subject matter expert for existing staff to ask questions.

PRIMARY RESPONSIBILITIES:

• Receives and responds to inquiries from all communication venues: e.g. phone, queue, department e-mail box or fax. Acts as a provider help desk specialist to aid providers in submitting prior authorization requests and communicating prior authorization request status
• Coordinates and assists initial screening of prior authorization requests via all communication venues; as well as administrative preparation for clinical staff
• Exhibits excellent phone and communication skills while providing complete and accurate information to customers
• Requests additional or supplemental information via correspondence in order to complete prior authorization requests
• Completes prior authorizations related to medications in the WellMed prior authorization system according to approved policies and procedures
• Issues oral and written prior authorization outcome notifications to providers and members that comply with standards and requirements for timeliness, content, and accuracy. Triages and resolves claims-related issues related to specialty drugs requiring prior authorization. Requests additional review by clinical staff as needed
• Compiles and reports data for ongoing key performance indicators and summarizes and presents findings to departmental leadership. Notifies manager of trends they observe
• Adheres to assigned schedule and quality metrics
• Provides clerical and/or administrative support to clinical staff and managers for special studies, projects and reports
• Provides excellent customer service by serving as a resource to all internal and external customers
• Attends required meetings and participates in special committees as needed
• Assists with training and onboarding of Medical Management Pharmacy Care Team Associates
• May act as a team lead for ad hoc projects and departmental initiatives as assigned
• Performs other 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.

• High School Diploma or GED
• 4+ years of experience in a medical or pharmacy setting
• 2+ years of administrative support experience
• Must be able to work independently, with some supervision and direction from manager
• Possesses medical terminology knowledge base
• General knowledge of CPT, HCPCS, and ICD-10
• Must possess and demonstrate excellent organizational skills, customer service skills, and verbal and written communication skills to include but not limited to patients, physicians, clinical staff, contracted providers and managers
• Working knowledge of Microsoft Office, Internet and e-mail
• Must maintain and demonstrate a high degree of professionalism to include both personal conduct and appearance at all times
• Must maintain strict confidentiality at all times to include but limited to patients and coworkers
• Must comply with all organizational policies regarding ethical business practices
• Must adhere to all department policies and procedures

PREFERRED QUALIFICATIONS:

• Certified Pharmacy Technician (CPhT) or Certified Medical Assistant training or certification
• 2+ years of experience with prior authorization or claims
• Knowledge of specialty pharmaceuticals
• Bilingual language proficiency (English/Spanish)

PHYSICAL & MENTAL REQUIREMENTS:

• Ability to lift up to 10 pounds
• Ability to push or pull heavy objects
• Ability to sit for extended periods of time
• Ability to stand for extended periods of time
• Ability to use fine motor skills to operate office equipment and/or machinery
• Ability to properly drive and operate a company vehicle
• Ability to receive and comprehend instructions verbally and/or in writing
• Ability to use logical reasoning for simple and complex problem solving

CAREERS WITH WELLMED. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 380,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi-specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team and a singular opportunity to do 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.

A Fortune 6 company, we're focused on helping people live healthier lives while making the health system work better for everyone. Here, we seek to empower people with the information, guidance and tools to make personal health choices. We work harder and we aim higher. We expect more from ourselves and each other. And, at the end of the day, we’re doing a lot of good for more than 142 million people worldwide.