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.
The Pharm Audit Quality Supervisor’s role is a combination of leadership/management of assigned staff to ensure timely execution of defined goals and deliverables as well as individual contributor responsibilities which include review and analysis of audit metrics, identify trends and root causes to develop processes for continuous quality improvement. The supervisor is expected to promote innovation, efficiency, and a culture of continuous improvement.
The position supervises a team of onshore technician auditors and indirect supervisor of an offshore team of auditors. Positions in this function analyze and monitor real-time and retrospective prior authorization cases to identify potential compliance risks and initiative and complete remediation as required. The supervisor oversees the conduct and management of multiple audits that include analyzing, reviewing, trending errors, and root causes as well as preparing reports and presentations.
You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
- Leads the team’s quality audits, compliance remediations and process improvement activities
- Diagnose process improvement opportunities and develop solutions using principles of process excellence
- Timely completion of daily audits, and monthly quality reporting, analysis
- Sets priorities for the team to ensure completion of audits and reports
- Coordinates activities with other supervisor and pharmacist teams
- Identifies and resolves problems using expertise and judgement
- Leading continuous improvement initiatives including creation, scoping and implementation
- Assist in the creation, implementation, and evaluation of Quality programs
- Harmonizes and standardize the quality reporting platforms with the Clinical and Health plan audits
- Identify training needs; Train and support the auditors and monitor effectiveness of training
- Communicate and coordinate with internal stakeholders to obtain required information to support the quality audit process
- Develop innovative ways to improve efficiency
- Establish a culture of continuous quality improvement.
The requirements listed below are representative of the knowledge, skill and/or ability required to successfully perform the duties and responsibilities for the position. Responsibilities requiring a higher level of skills such as developing reports and presentation are assumed as proficiency and accuracy in the quality reviews is achieved.
Functional Competency and Descriptions:
- Responsible for leading continuous improvement initiatives including creation, scoping and implementation
- Navigate multiple computer programs and reports 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
- Develop and or update Job Aids for Quality Technicians
- Develop Quality Improvements; initiate and track process-improvement actives as appropriate based on quality review findings
- Partner with other members of the team to evaluate adherence to policies and consistency of processes
- Analyze results of monthly quality data elements to assist in the creation of monthly quality reports and presentations
- Prepare daily reports including but not limited to authorization errors and missed reviews
- Provide coaching and training of technician auditors
- Evaluate on continual basis the quality platform to harmonizing quality definitions with rest of the quality team
Skills:
- Conduct root cause analysis (e.g., Why analysis) on performance metrics (e.g., error trends) to establish remediation tactics and identify opportunities for quality and process improvements
- Work with relevant business partners (e.g., IT) to plan and implement recommended enhancements and improvements
- Professional competence, knowledge, and skills to accurately and effectively quality review
- Skilled in CMS Medicare Part D rules and prior authorization reviews
- Working knowledge of drug dosage forms, drug strength, generic & trade name equivalent
- Ability to multi-task and maintain a balance of productivity, quality, and timeliness of job accountabilities
- Ability to validate processes followed by operation technicians processing cases against job aids and communications
- Excellent oral and written communication skills
- Ability to match data elements on reports and data mine to identify opportunities to standardize quality reporting and inconsistencies
- Intermediate-level computer skills with ability to learn new systems quickly and efficiently as well as the ability to navigate and use multiple systems at the same time
- Solid organizational skills are required with the ability to multi-task
- Must possess a solid attention to details and high level of accuracy
- Ability to work in a team environment as well as independently
- Ability to identify problems including complex issues and help determine solutions, both independently and in a team/group setting
- Ability to adjust based on business/department needs
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.
Required Qualifications:
- High school diploma or GED
- Active/current National Pharmacy Technician Certification (i.e., ExCPT, NCCT, PTCB)
- 2+ years of recent experience in prior authorization
- Experience in using PAS and RxClaim systems
- Knowledge of Medicare Part D rules and processing (especially compliance related)
- Proficient in Microsoft Office Suite including WORD, EXCEL, OUTLOOK, SharePoint preferably POWERPOINT
- Proven excellent verbal and written communication skills
Preferred Qualifications:
- Experience in a supervisory or lead role
- Background or ability to program SharePoint fields
Schedule:
- This position is full-time telecommute (40 hours/week or more as required)
- The work schedule with be Monday – Friday from 9am – 5:30pm EST, with the ability to adjust work schedule based on business needs
- Rotating holidays
- Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of (8am-6:30pm EST)
- It may be necessary, given the business need, to work overtime
California, Colorado, Connecticut, Nevada, New Jersey, New York, Rhode Island, or Washington Residents Only: The salary range for California, Colorado, Connecticut, Nevada, New Jersey, New York, Rhode Island or Washington residents is $56,300 to $110,400 per year. Pay is based on several factors including but not limited to education, work experience, certifications, etc. 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. APPLY HERE