$19.47 - $38.08 Hour
Monday to Friday
Day shift
Health insurance
Paid time off
Employee discount
Dental insurance
Vision insurance
401(k)
401(k) matching
Flexible schedule
Parental Leave
Tuition reimbursement
Flexible spending account
Retirement plan
Others
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 the 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.
This will be a Sunday-Thursday schedule with an 8 hour shift needed each day between the hours of 8:00am CST and 8:30pm CST.
You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
This position is responsible for quality audit, reporting, analysis and identifying compliance issues and remediation for programs to support continuous quality improvement using applicable tools.
The role of the Quality Business Operations Specialist is to:
Perform/Measure/Document and Report Performance and Quality Audits- Perform internal quality audits to ensure accuracy of work (e.g., data entry; reporting; quality errors)
Make appropriate corrections to identified discrepancies (e.g., incorrect dates; data errors)
Communicate results to key stakeholders using internal procedures and documentation
Conduct root cause analysis on performance metrics such as error trends
Identify compliance risks, remediate errors and provide feedback to reduce errors and improve processes and performance
Positions in this function may also be responsible for quality reporting, analysis, and audits, and for developing plans and programs to support continuous quality improvement using applicable tools
Support/Coordinate/Perform Special Projects: Provide input into and/or create supporting documentation (e.g., reports; presentation materials) for special projects
Provide information, assistance, and/or oversight to facilitate project implementation
Demonstrate Knowledge of Operations Systems, Tools, and Processes -Demonstrate understanding of relevant federal and state regulatory guidelines (e.g., CMS)
Demonstrate understanding of standard operating procedures, policies, and processes
Primary Responsibilities:
Perform quality review of Medicare coverage determinations and cancel cases to determine the following 1) accuracy of review 2) timeliness 3) correctness of authorization placement 4) compliance errors 5) Adherence to Clinical Policies and Procedures
Navigate multiple computer programs to review and document the accuracy of case reviews, report errors and remediate as directed
Develop and maintain a clear understanding of Medicare policies and procedures
Identify compliance issues and address escalated Medicare compliance issues to ensure compliance
Identify and document errors and issues identified from case reviews
Identify errors and Initiate and track individual case remediations
Partner with other members of the team to evaluate adherence to policies and procedures
Load daily cases for monitoring on Quality SharePoint
Entering errors on the I/O Log
Developing reports of quality review
Meet case review goals
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.
Preferred Qualifications:
Active/current National Pharmacy Technician Certification (i.e., eXCPT, NCCT, PTCB)
Previous experience in using PAS and RxClaim systems
Sharepoint and Planner experience
*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, or Washington Residents Only: The hourly range for this role is $19.47 to $38.08 per hour. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.
Communication
Leadership
Teamwork
Interpersonal
Learning/adaptability
Self-management
Organizational
Computer
Problem solving
Open mindedness
Strong work ethic
technology
Others
HS Diploma or 2+ years of Business Operations Experience
Pharmacy Technician License in the state you reside
2+ years of experience in Prior Authorization or related field
2+ years of experience working with Medicare Part D rules and processing (especially compliance related)
Intermediate proficiency with MS Office Products (Word Excel PowerPoint)
Able to work Sunday-Thursday each week
Able to work an 8 hour shift between 8am CST – 8:30am CST
Health care
4
Remote