Pharmacy Audit Supervisor - Cypress, CA - Full-time / Part-time

Position Description:


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.

 

This opportunity is with one of our most exciting business areas:
Optum - a growing part of our family of companies that make UnitedHealth Group
a Fortune 14 leader.

 

Optum helps nearly 60 million Americans live their lives to the
fullest by educating them about their symptoms, conditions, and treatments;
helping them to navigate the system, finance their Healthcare needs, and stay
on track with their Health goals. No other business touches so many lives in
such a positive way. And we do it all with every action focused on our shared
values of Integrity, Compassion, Relationships, Innovation, and Performance.

Primary Responsibilities:
Provide daily oversight on quality reviews of new and changed benefit plan set-up for accuracy which include:Review completed projects for accurate implementation based on project requests received;Perform test claims (as applicable) and document results to ensure requests were completed accurately in the system;Perform root cause analysis of errors identified (if applicable);Assess and communicate financial impact of the errors identified to Benefit Operations Management (BOM) (if applicable);Validate audit findings with affected parties and confirm corrected (if applicable);Recommend solutions to mitigate/fix the errors noted
and review them with affected parties for an agreed upon approach, as
appropriate;Document work performed and audit results based on pre-determined standards and guidelines.May be assigned to work on special projects and business initiatives.Line Management
Interview, hire, and ensure proper training is provided to all new Quality Review Analyst;Provide direct supervision of the work performed by the Quality ReviewAnalyst to ensure timely and accurate closure of assigned projects;Provide coaching and development of subordinates;Prepare and deliver to subordinates performance appraisal (new hire and annually);Address all performance issues following the UHG disciplinary processReview departmental policies and procedures for updates;Support the development of training materials produced by 3D Learning;Ensure all performance guarantees related to turn-around time are met or exceeded;Complete assessment when performance guarantees are not met or when errors occur to determine root cause and error prevention;Ensure appropriate staffing levels;Ensure staff completes all ULearn training timely;Meet regularly with staff member for goal setting and feedback;Host regular staff meeting with all direct reports;Achieve department goals and objectives;Support and enforce all company policies and procedures.Reporting
Ensure completion of inquiries from Proposal Unit,
Client Management, Clinical, and other internal partners on data
requests including:Create spreadsheets and macros, compile, analyze data in an efficient and effective manner;Present data in a detailed and summary level for different level of reviews;Provide detailed input to root-cause analysis and resolution for errors identifiedSupport all quality review data reporting needs within BOM or special projects.

Required Qualifications:

Bachelor’s Degree Less than 10 % of travel annually
to different work sites required 2+ years of management/supervisory
experience 2+ years Pharmacy Benefit Management,
Retail Pharmacy, or Healthcare experience Proficiency with Microsoft Excel to develop
pivot tables, formulas, v-lookups, macros, and create reportsProficiency with Microsoft PowerPoint to
create/edit presentations to convey findings of audits and analysis

Preferred Qualifications:

Certified Pharmacy Technician Certified Quality Auditor or Certified
Internal Auditor Internal auditing or pharmacy auditing
experience RxCLAIM experienceUnderstanding in audit, controls, and
business process improvements (Six Sigma, Internal Audit)

Soft Skills:

Strong written and verbal communication
skills  Strong analytical  skills Detail-oriented

OptumRx is
an empowering place for people with the flexibility to help create change.
Innovation is part of the job description. And passion for improving the lives
of our customers is a motivating factor in everything we do.

 

If you're ready to talk about groundbreaking
interactions, let's talk about what happens when a firm that touches millions
of lives decides to gather results from millions of prescriptions every month
and analyze their impact. Let's talk about smart, motivated teams. Let's talk
about more effective and affordable healthcare solutions. This is caring. This
is great chemistry. This is the way to make a difference. We're doing all this,
and more, through a greater dedication to our shared values of integrity,
compassion, relationships, innovation and performance.  Join us and start doing your life’s best work.SMDiversity 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.