UCare

Pharmacy Clinical Operations Coordinator

7 days left

Employer
UCare
Location
Minneapolis, Minnesota
Posted
Dec 30, 2021
Closes
Jan 26, 2022
Ref
2730
Category
Healthcare
Employment Status
Full Time
Health Care that Starts with You!

Join a truly mission-driven organization! Independent, nonprofit UCare is recognized as one of the Minnesota's leading health plans. We provide more than 225,000 members across Minnesota and western Wisconsin with the health coverage plans and services they need to maintain and improve their health. The innovative coverage we create makes a difference for Medicare-eligible individuals, individuals and families enrolled in Minnesota Health Care Programs, such as MinnesotaCare and Medical Assistance, and disabled adults with special health care needs.

UCare is growing in size, membership, products, geographic coverage, and employees. We're an organization that's going places. Be part of a team that cares about you, be part of UCare.

Rewards

Enter a highly collaborative environment where people are truly engaged, and feedback is valued. You'll enjoy a competitive salary and benefits, as well as a host of other perks, including a nationally recognized wellness program, and a bright, open, award-winning office space in Northeast Minneapolis just minutes from major freeways and retail centers.

At UCare, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.

www.ucare.org/careers/

EOE/AA

ABOUT UCARE

UCare offers Medicare, Medicaid, Individual and Family health plans - powered by the hardest working people in the industry. Our people powered teams de-complicate, advocate and always go the extra mile to help our members. We serve with integrity, compassion and commitment to do right by members, providers and government partners. Above all, we come to work excited to provide members a path for the best health of their lives.

WORKING AT UCARE

Working at UCare is more than a career; it's a mission. A mission that defines us as professionals, unites us as an organization and shapes how we interact with our members and each other. Employees join UCare and stay because of the opportunity to have a purpose-driven job.

Our strong culture has established UCare as a Star Tribune Top 150 Workplace for 12 consecutive years since the awards program began. It's a culture that embraces innovative ideas, strategic partnerships, and exemplary customer and provider experiences. Working at UCare is being a part of a people powered team dedicated to making a real difference in the lives of our members and communities.

PHARMACY CLINICAL OPERATIONS COORDINATOR

Work Location: Work from home, in the office or hybrid (in the office 3 or more days per week)

The health and safety of our employees, members, providers, and our community is our highest priority. Therefore, all new employees are expected to be fully vaccinated against COVID-19 prior to starting at UCare, subject to limited exceptions such as for a sincerely held religious belief or for medical reasons.

Position Description

This position is responsible to ensure medical drug authorization information is documented and communicated appropriately and accurately for member and provider support. Provide daily oversight of entry of medical drug authorizations into both the utilization management platform and claims system. Assist in answer questions related to medical drug authorization requirements and claims processing. Assist with facilitating regulatory submissions for clinical programs and monitoring for regulatory oversight. Provide back-up support for clinical pharmacy documentation requirements. This role requires strong problem-solving, communication skills, organization skill and the ability to assimilate information and data from multiple sources.

• Develop and maintain an understanding of UCare products, benefits, pharmacy operations and clinical programs; including formulary knowledge, benefit management, materials, regulatory oversight; and appropriate drug claims processing.

• Apply knowledge and skills to a range of assignments requiring collaboration within pharmacy and across UCare including claims, IT, enrollment, finance, customer service, marketing, and quality.

• Prepare and update medical drug authorization policies for posting on the UCare website. Maintain an accurate medical drug authorization grid for posting on the UCare website.

• Ensure medical drug claims are processing appropriately according to the medical drug authorization requirements and research and resolve any complex issues in a timely and professional manner. Ability to seek out UCare resources to bring issues to closure.

• Perform daily tasks for ensuring the accurate authorization entry into the utilization management platform and claims processing system through the review of daily reports and acting to correct any identified issues.

• Coordinate, prioritize, schedule and manage review of existing department policies/procedures and facilitate documentation and development of new department documents.

• Assist with the development, analysis, and processing of both ad-hoc and regulatory required reporting and audits on medical drug data; and address outcomes as necessary.

• Provide back-up support day to day formulary management duties including: prepare and update formulary documentation for posting and distribution, prepare and analyze formulary files for updates and changes, collaborate with vendors to support formulary requirements, review findings and suggestions with Pharmacy Management team, understand and implement regulatory aspects (both CMS guidance and DHS regulations) of formulary maintenance.

• Other projects and duties as assigned.

Education

BA/BS preferred; demonstrated experience may be considered in lieu of degree. Pharmacy Tech CPhT preferred.

Required Experience

Three years of pharmacy operations experience in a PBM or health insurance setting. One year of project coordination experience in a health care environment.

Preferred Experience

Medicare Part D, State Public Programs and Healthcare Reform knowledge. Experience in gathering, translating and communicating technical business requirements. Proficiency with data analysis and validation. Strong knowledge of MS office products including Word, PowerPoint, and Excel. Process improvement experience. Background in policy and procedure development. Experience working with medical claims.

THE UCARE DIFFERENCE

The UCare difference is our people power - employees actively working on the behalf of our members to get them access to the health care they need. We value and respect each individual's ideas and contributions and provide the freedom to grow both personally and professionally. We are centrally located, and offer onsite education, equipment and wellness resources, and a myriad of volunteer activities. If you're looking for an inclusive environment that celebrates your people power, helps you build on your strengths and gives you the opportunity to truly make a difference, we invite you to apply.

As an Equal Opportunity/Affirmative Action Employer, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.

Job Post Date: 12/29/2021

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