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Position Description

Energize your career with one of Healthcare’s fastest growing companies. 

You dream of a great career with a great company - where you can make an impact and help people. We dream of giving you the opportunity to do just this. And with the incredible growth of our business, it’s a dream that definitely can come true. Already one of the world’s leading healthcare companies, UnitedHealth Group is restlessly pursuing new ways to operate our service centers, improve our service levels and help people lead healthier lives. We live for the opportunity to make a difference and right now, we are living it up.

As one of the largest pharmacy benefits managers in the United States, UnitedHealth Group provides a professional culture where you're empowered and encouraged to exceed the expectations of our members, with better schedules than retail and more reach than any hospital. At Optum, a growing part of our family of companies that make UnitedHealth Group a Fortune 6 leader, you'll find better schedules than retail and more reach than any hospital. You'll open doors for yourself that simply do not exist in any other organization, anywhere. Take this opportunity to start doing your life's best work.(sm)

  • Multiple positions available at this time*** 

Optum Puerto Rico Operations is creating an innovative approach to Pharmacy Benefit Management. As a Pharmacist - Prior Authorization, you will work in a corporate call center based business environment where strict work guidelines are employed. As a Pharmacist - Prior Authorization, you will be responsible for evaluating Prior Authorization cases and rendering coverage determinations based on clinical criteria and plan design in a fast paced and dynamic environment.

Primary Responsibilities:

  • Work in computer based and includes 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
  • 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
  • ENGLISH PROFICIENCY ASSESSMENT WILL BE REQUIRED AFTER APPLICATION ***

This position is full-time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8 hour shift schedules during our normal business hours of 7:00am – 11:00pm AST. It may be necessary, given the business need, to work occasional overtime or weekends. Our office is located in the Montehiedra area in San Juan.

Required Qualifications:

  • Active, unrestricted Pharmacist license in Puerto Rico.
  • Drug product and clinical pharmacy knowledge.
  • Experience using online clinical references and accessing professional (clinical and regulatory) internet sites
  • Experience working with onscreen document images
  • Computer and typing proficiency, including MS Office applications (Word, Excel, PowerPoint and Outlook)
  • Ability to work regularly scheduled shifts within our hours of operation including the training period, where lunches and breaks are scheduled, with the flexibility to adjust daily schedule, and work over-time during peak season and/or weekends, as needed
  • Bilingual Spanish / English

Preferred Qualifications:

  • 1+ years practicing pharmacist experience
  • PBM experience
  • Pharm D
  • Experience in Commercial (private), and/or Medicare Part D prescription drug plans, programs or formularies
  • Experience in Coverage Determinations (prior authorization) or member appeals
  • Problem-solving skills

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Job Keywords: Pharmacist, Prior Authorization, Recent graduate, San Juan, Puerto Rico 

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Confirmed 18 hours ago. Posted 29 days ago.

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