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.

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.

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 10:30am – 7:30pm 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.

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:

• Active, unrestricted Pharmacist license or Pharmacist Intern (Pharm D) license in Puerto Rico or ability to obtain within 90 days of hire
• Experience using online clinical references and accessing professional (clinical and regulatory) internet sites
• Experience working with onscreen document images
• Drug product and clinical pharmacy knowledge
• Computer and typing proficiency, including MS Office applications (Word, Excel, PowerPoint and Outlook)
• English proficiency
• 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
  

Preferred Qualifications:

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

Careers with Optum. Our objective is to make health care simpler and more effective for everyone. With our hands at work across all aspects of health, you can play a role in creating a healthier world, one insight, one connection and one person at a time. We bring together some of the greatest minds and ideas to take health care to its fullest potential, promoting health equity and accessibility. Work with diverse, engaged and high-performing teams to help solve important challenges.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

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.