[Hiring] Senior Pharmacy Care Coordinator @UnitedHealth Group

Role Description

The Senior Pharmacy Care Coordinator supports prior authorization operations through advanced administrative processing and pharmacy-focused coordination. This role does not perform clinical review or medical necessity determinations but applies knowledge of pharmacy benefits and workflows to ensure accurate case processing and support cost-effective medication utilization through provider outreach.

Schedule: A 40-hour work week, Monday through Friday 8:00am to 5:30pm PST. Rotating Saturday between 8:00 am to 12:00 pm PST. The schedule will be determined by the supervisor upon hire.

Location: Remote Nationwide. You will enjoy the flexibility to telecommute from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Process and manage pharmacy prior authorization requests, ensuring completeness and accuracy of submitted information.
• Review requests against established guidelines such as formulary and step therapy requirements to support appropriate routing and next steps.
• Conduct outbound outreach to provider offices to communicate authorization requirements, formulary alternatives, or step therapy options.
• Document case activity, outreach, and updates in system tools in accordance with standard procedures.
• Coordinate with intake, clinical teams, and providers to ensure timely case progression and resolution of issues.
• Identify and escalate complex or incomplete requests as needed.
• Performs other duties as assigned.

Qualifications

• High School Diploma/GED.
• 3+ years of experience in prior authorization, pharmacy operations, or healthcare administrative support.
• 1+ years of organizational skills and ability to manage programs with outcomes.
• 1+ years of computer proficiency experience.
• Ability to work a 40-hour work week between 8:00am to 5:30pm and rotating Saturdays from 8:00 am to 12:00 Pacific Standard Time.
• Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection and installation.
• Candidate must have their own home internet access (internet can be hard wired with Ethernet cord).
• Must be on camera for all team’s calls/meetings.
• Required to have a location/workspace in the home that is separate from non-workspace areas and can be secured to maintain PHI or PII security in line with UnitedHealth Group policies and standard.
• Ability to keep all company sensitive documents secure (if applicable).

Preferred Qualifications

• 1+ years of experience as a pharmacy technician or medical assistant.
• 1+ years of experience in a physician’s clinic or hospital.
• Experience with prior authorization workflows, case processing, and system documentation.
• Previous Epic or similar Electronic Medical Record (EMR) experience preferred.
• Knowledge of pharmacy terminology, drug classifications, and formulary concepts.

Soft Skills

• Operating a computer, calculator, photocopy machine, and document scanner.
• Ability to work independently and maintain good judgment and accountability.
• Demonstrated ability to work well with health care team.
• Strong organizational and time management skills.
• Ability to multi-task and prioritize tasks to meet all deadlines.
• Ability to work well under pressure in a fast-paced environment.
• Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying information in a manner that others can understand, as well as ability to understand and interpret information from others.

Benefits

• Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays.
• Medical Plan options along with participation in a Health Spending Account or a Health Saving account.
• Dental, Vision, Life & AD&D Insurance along with Short-term disability and Long-Term Disability coverage.
• 401(k) Savings Plan, Employee Stock Purchase Plan.
• Education Reimbursement.
• Employee Discounts.
• Employee Assistance Program.
• Employee Referral Bonus Program.
• Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.).