Job Description

Job Description

Job Description

Location: Remote
Pay Rate: $50 to $55 an hour (Depending upon the experience)

Primary Responsibilities:

• Work is computer based and include receiving phone calls from prior authorization pharmacy technicians and/or providers for clinical information
• Consult physicians/providers with questions, interpret clinical guideline criteria, and render/review coverage determination for prior authorization cases
• Consult with pharmacy technicians and/or physicians regarding use of medications and advise of appropriate formulary alternatives when requested.
• Have sharp attention to detail, Using established criteria and guidelines, Gather complex clinical information, coverage policy and criteria information and work within regulatory guidelines to make coverage determinations
• Organize workload, sets priorities, completes assignments in a timely manner and utilizes resources appropriately while complying with department program standards
• Perform all duties and functions in compliance with state and federal pharmacy laws and regulations
• Conform with and supports department quality assurance and improvement guidelines
• Dedication to build rapport with coworkers, internal customers, and other departments by demonstrating a strong customer service orientation and a continuous positive image of OptumRx.
• Demonstrate ability to maintain productive working relationships with team members, other internal and external customers, and management team.
• Patient Safety and Quality of work is paramount and it’s important for employees to have a safe and secure workspace and communicate with their leadership when that safety (equipment, system, information) is compromised
• Resolve issues and complaints in a timely manner
• Performs other duties as assigned by management
• Training is for 5 weeks. Training time is 8:00am-5:00pm local time. Monday- Friday. This training time is subject to change
• Shift after training is an 8-hour shift with an hour lunch. Candidate must be available as early as 5am and as late as midnight
• Candidate will work 5 days a week which may or may not include a weekend day(s)
• There may be scheduled overtime and/or working on holidays dependent on business needs
• Candidate must have their own home internet access (internet can be hard wired with Ethernet cord)
• Candidate must also have a secure workspace/office in their home
• Candidate must have level skill with working with PC (ex. using mouse and keyboard, accessing and navigating through multiple systems and screens)
• Excellent attendance is a must.

Required Qualifications:
Pharmacists: Bachelors or Doctorate of Pharmacy; Active State Pharmacist License.
6 + months of Customer Service/Customer Relations with Healthcare professionals.
Basic proficiency with Microsoft Excel (ability to create, edit, and save a basic spreadsheet), Microsoft Word (ability to create, edit, and save a basic document), and Microsoft Outlook (ability to send emails).
Able to work 5am to 12 midnight with ability to work flexible hours, including OT and weekends. Company Description

Pride Health is a leading minority-owned healthcare recruitment & staffing firm that offers highly customized business process solutions at cost-effective prices.
Headquartered in New York City as a top minority supplier, PRIDE Health offers a broad geographic reach with offices throughout the U.S., India, and Brazil. Leveraging more than 20 years of experience, PRIDE has enhanced its core competency of IT staffing services by creating client-centric, cost-effective IT, and business process solutions. PRIDE serves Client-Partners in the healthcare, IT, financial services, retail and insurance industries offering both Direct Hire and Temporary Staff of Healthcare Professionals, Vendor Management Systems, IT Hardware Procurement Services, and Business Processing Outsourcing.

Temporary, Contract, Per Diem & Direct Hire staffing solutions are only part of what we can offer our clients.

Company Description

Pride Health is a leading minority-owned healthcare recruitment & staffing firm that offers highly customized business process solutions at cost-effective prices.\r\nHeadquartered in New York City as a top minority supplier, PRIDE Health offers a broad geographic reach with offices throughout the U.S., India, and Brazil. Leveraging more than 20 years of experience, PRIDE has enhanced its core competency of IT staffing services by creating client-centric, cost-effective IT, and business process solutions. PRIDE serves Client-Partners in the healthcare, IT, financial services, retail and insurance industries offering both Direct Hire and Temporary Staff of Healthcare Professionals, Vendor Management Systems, IT Hardware Procurement Services, and Business Processing Outsourcing.\r\n\r\nTemporary, Contract, Per Diem & Direct Hire staffing solutions are only part of what we can offer our clients.

Job Tags

Holiday work, Contract work, Temporary work, Local area, Remote job, Flexible hours, Shift work, Night shift, Monday to Friday,

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