Senior Pharmacy Care Coordinator - Remote - West Region

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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. Hours/Location: Must reside in Pacific or Mountain Time Zone. Variable hours to work 8-hours within the hours of 8:30 AM - 6:00 PM Pacific Standard Time Monday - Saturday based on business needs. You'll enjoy the flexibility to work remotely

• from anywhere within Pacific or Mountain Standard Time Zones in the U.S. as you take on some tough challenges.
• Primary Responsibilities:
• Rebate Management: This position oversees the comprehensive rebate process, encompassing claim analysis, attestation, preferred communication methods, claim submission, and audit coordination. Support the full rebate data engineering lifecycle including research, proof of concepts, design, development, testing, deployment, and maintenance of rebate data management solutions. The role is charged with implementing industry's best practices, minimizing operational risks, and promoting ongoing improvements in efficiency throughout all rebate-related activities
• Data and Trend Management:
• Perform as an individual contributor by querying a variety of data sources, wrangling data, and building visually appealing dashboards and reports to identify insights and opportunities
• Analyze, review, forecast, and trend complex rebate data to support enterpriselevel decision making
• Build and maintain complex rebate models, calculators, templates, and simulations to support forecasting, planning, and scenario analysis
• Ensure timely and accurate delivery of consolidated rebate claims that serves as the single source of truth for rebate collection projection, tracking, payment reconciliation and other rebate program performance metrics
• Medication Access: Support access to medications by evaluating benefit options following UM (utilization management) determinations, including coverage denials or redirections. The role involves structured investigations to determine coverage under both medical and pharmacy benefits according to payer guidelines and plan requirements. Key tasks include confirming patient insurance eligibility and evaluating coverage standards across different benefits. This process may require examining prior authorization requirements, formulary placement, site-of-care policies, and potential patient cost implications
• Care Coordination: Work closely with physicians, advanced practice providers, nurses, pharmacists, and other healthcare professionals to promote coordinated care and effective medication management. The position requires proactive communication with other healthcare professional via phone, fax, and other electronic channels
• Cross-Functional Team Collaboration: Collaborate with various cross-functional teams to implement strategic projects that improve care delivery and network operations, ensuring compliance and maintaining high clinical standards. These teams span areas such as pharmacy management, utilization management, payment integrity, claims processing, health economics, finance, and contracting
• Compliance and Regulatory Requirements: Adhere to organizational policies related to affordability programs, patient confidentiality, and medication safety. Follows relevant regulatory guidelines, policies and procedures in reviewing clinical documentation (e.g., SOP's and Job Aids)
• Continuous Improvement: Engage in quality improvement activities and process enhancements aimed at increasing the efficiency and impact of affordability programs
• Additional Duties:
• Anticipate leader needs by engaging in creative problem solving and ideation to bring new, relevant content to Operations
• Work independently with minimal guidance while proactively escalating complex issues and risks
• Applies a team approach to solving complex problems
• Adapt team priorities to ensure task completion
• Prepare medication utilization and prior authorization requests for specialty oncology and non-oncology ambulatory injectable and/or infusion medications as related to member benefits, health plan coverage, site of service, and evidence based clinical guidelines
• Solves moderately complex problems and/or conducts moderately complex analyses and translates concepts into practice
• Identifies incomplete/inconsistent information in medical records and label missing measures/metrics/concerns as well as evaluate

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