Sr Pharmacy Care Coordinator - National Remote

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Optum is a global organization that delivers care, aided by technology, to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with care, pharmacy benefits, data, and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits, and career development opportunities.

Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

The Sr Pharmacy Care Coordinator will collaborate with members, providers, and an interdisciplinary team focused on assuring safe and appropriate utilization of professionally administered medications. This role supports the UM pharmacist in providing urgent and routinely requested medication determinations in a time sensitive manner to help facilitate professionally administered medication treatments for Optum delegated members.

Schedule: Monday - Friday 8:30am - 5:30pm PST, with rotating Saturdays (approx. 8:00am - 12:00pm, once every 8 weeks)

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

Primary Responsibilities

• Consults with and coordinates initial set up of and on-going requests for medication prior authorization, scheduling Pharmacist consultation meetings, and documenting outcomes in a professional manner
• Communicates directly with providers/designees when appropriate to gather all clinical information to assist in determination of the medical necessity of requested healthcare services and refers to appropriate staff for higher level of review when indicated
• Prepares utilization reviews of professionally administered medications using criteria and verifies benefits for services using health plan benefits and coverage
• Manages and follows relevant time limit standards necessary for conducting and communicating utilization review determinations in collaboration with UM pharmacists
• Prepares for oversight audits by the health plans and responds to documentation requests as directed
• Follow up with ancillary contracted entities if services or resources have not been made available to the member to assure that pharmaceutical needs are being met
• Reviews written requests for clinical services for necessary documentation and forwards to Utilization Management Pharmacist or Medical Director when necessary
• Interfaces with referring practitioners or staff, to facilitate prescribing of pharmaceutical alternatives within specified time restrictions
• Participates in process improvement projects and team meetings as required
• Responds to questions from medical offices, hospitals, and members about the necessary steps of the medical and pharmaceutical referral authorization processes and medication copay assistance alternatives
• Assists with preparation of utilization review authorizations, both verbal and written to assure high continuity of care for all managed care members in the program and consistency of gathering specific information within the department to comply with policies and procedures
• Works closely with members, member’s family, and interdisciplinary team to ensure proper information is disseminated to all stakeholders in a compliant fashion
• Works closely with the UM Clinical Pharmacy Manager to obtain timely decisions on pended referrals and requests for medical services from health plans and providers as needed
• Other duties as assigned
• 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
• 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…