Prior Authorization Supervisor - Costa Mesa, CA

Position Description:

When you are in the business of health care, you're in the business of people. At UnitedHealth Group we want every customer experience to be distinctly personal. The challenge is complex. When people call us for help, their focus is on getting the best care possible. We help them understand their benefits and their options. This part of their lives matters a lot to them and it matters just as much to us. Our customer service teams have a serious responsibility to make every contact informative, productive, positive, and memorable for what it says about how much we care.

The essential functions of a pharmacy technician in Prior Authorization are providing expertise and customer service support to members, customers, and/or providers. This position exists to take incoming requests for prior authorizations, for formulary and non formulary medications, while ensuring a high level of customer service and maximizing productivity. Request can be received via fax or telephone, from providers' offices and pharmacists. The position provides clinical review for authorizations in keeping with legal and contractual requirements, including but not limited to turn around times (TATs) and service level agreements (SLAs). The technician must provide the information clearly, accurately and in a professional manner. Interactions with callers must be documented per contractual and various regulatory / legal requirements.

Positions in this function are responsible for providing expertise and customer service support to members, customers, and/or providers. Direct phone-based customer interaction to answer and resolve a wide variety of inquiries.

Primary Responsibilities:

• Coordinates, supervises and is accountable for the daily/weekly/monthly activities of a team members
• Sets priorities for the team to ensure task completion and performance goals are met, such as Quality, Adherence, Service Level and AHT
• Coordinates work activities with other supervisors, managers, departments, etc
• Identifies and resolves operational problems using defined processes, expertise and judgment
• Provides coaching and feedback to team members, including formal corrective action
• Conducts annual performance reviews for team members
• Provides expertise and customer service support to members, customers, and/or providers
• Using established criteria and guidelines, the pharmacy technician receives and processes prior authorization requests made by providers and members for medications not inherently covered on a member's prescription drug plan
• Answer prior authorization inquiry calls or/and faxes as well as research and resolve formulary and benefit issues using the appropriate reference material
• Resolve issues and complaints in a timely manner
• Performs other duties as assigned by management
• Handles inbound phone requests and gathers member data to provide to information for Pharmacist consultations
• Coordinates, supervises and is accountable for the daily activities of business support, technical or production team or unit
• Impact of work is most often at the team level

Requirements:

• High School Diploma/ GED
• Basic to Intermediate level of proficiency with MS Word, Excel and Outlook
• 1+ years of experience coaching/ team lead
• 3+ years call center experience
• MUST Possess a Valid Pharmacy Technician within 6 months of hire

Assets:

• Prior Authorization experience
• Call Center Management tools experience (Ayana, CMS Supervisor, TotalView, IEX, etc)
• Bachelor's degree
• Valid Pharmacy Technician license

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.