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in Pittsburgh, PA

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Hours Full-time, Part-time
Location Pittsburgh, PA
Pittsburgh, Pennsylvania

About this job

Position Description:

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. Join us and start doing your life's best work.(sm)

Candidates for the Pharmacy Lock In Technician will work with the clinical pharmacy team members focusing on the reduction of fraud waste and abuse in the pharmacy benefit.  The selected candidate will have a strong pharmacy background and have knowledge of frequently abused medications and have the ability the identify pharmacy related trends that are consistent with fraudulent activities.  The chosen candidate will need to have strong relationship skills, a comfort level of working with a mix of individuals including but not limited to, pharmacy executives, health plan executives, state employees, members, and providers.  The chosen candidate will be required to work independently and make independent decisions based off of policies and procedures that will be provided. 

Primary Responsibilities:
  • Uses pertinent data and facts to identify potential pharmacy related fraud waste and abuse.
  • Serve as a liaison between the pharmacy department and health plan fraud waste and abuse departments.
  • Use information provided to build member specific cases to support pharmacy lock in / recipient restriction referrals to be submitted to state Medicaid departments for review
  • Maintenance of active grid of members who are approved for restriction programs
  • Administrative responsibilities associated with pharmacy restriction programs including but not limited to mailing of notifications to members and providers, outbound phone calls to providers to discuss member restriction if needed.  
  • Serve as subject matter expert for appealed restrictions and state fair hearings
  • Prioritizes and organizes own work to meet deadlines.
  • Provides explanations and information to others on topics within area of expertise. 
  • Ad hoc projects as assigned

Requirements

Required Qualifications:
  • High School Diploma/GED.
  • 2+ years of Healthcare Industry experience.
  • Experience using Word and Excel to perform job functions.
Preferred Qualifications:
  • Experience working in a Managed Care position.
  • Active PA Pharmacy Tech license.
  • Pharmacy experience.
Physical Requirements and Work Environment:
  • Frequent speaking, listening using a headset, sitting, use of hands/fingers across keyboard or mouse, handling other objects, long periods of close vision looking at a computer monitor
  • Service center environment with moderate noise level due to Representatives talking, computers, printers, floor activity
Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 14 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work.


Diversity creates a healthier atmosphere: 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.