Senior Claims Manager Jobs in Puerto Rico (NOW HIRING)

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.    

The Clinical Pharmacist will report to the Operations Team Leader. This role is primarily responsible for performing telephonic consultations with members to complete comprehensive medication reviews, adherence related consultations, and improve disease state management. In addition, the Clinical Pharmacist will document the delivery of care and communicate essential information to the member's primary care providers.

Primary Responsibilities: 

• Engage members telephonically and schedule pharmacist consultation appointments with members that participate in any of the clinical programs operationally supported by the Clinical Engagement Services Center
• Prioritize the privacy and confidentiality of the patient's medical information, adhering to HIPAA regulations, and organizational policies at all times
• Utilize prescription claims data to generate clinical recommendations according to Medication Therapy Management and Retrospective Drug Utilization Review program protocols providing clinical recommendations pertaining to, but not limited to, gaps in care, high risk medications, compliance and adherence, drug interactions, therapeutic substitution, and generic substitution
• Assess medication regimen for unnecessary medications, ineffective medications, inappropriate doses, and adverse drug reactions
• Provide patient education on medication regimen and disease states
• Accurately document patient care notes and recommendations in an efficient, professional, concise and clear manner
• Keep current with new and emerging clinical trends
• Active participation in departmental meetings to improve clinical programs and enhance processes
• Follow all policies and procedures related to job
• Meet productivity and performance expectations set forth by management
• Support Clinical Service Engagement team as needed for special projects
• Other duties as assigned by Operations Manager

 ***ENGLISH PROFICIENCY ASSESSMENT WILL BE REQUIRED AFTER APPLICATION*** 

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications: 

• Active, unrestricted Pharmacist license or Pharmacist Intern (Pharm D) license in Puerto Rico
• Experience working independently within a cross functional team environment, self-directed with excellent organizational skills
• Solid knowledge of drug products and clinical pharmacy
• Computer proficiency, including the use of Microsoft office applications
• Solid English communication skills (written and verbal)
• Ability to work a flexible schedule with rotating shifts between the hours of 9:00 AM and 10:00 PM AST, Monday through Friday. Extended hours and occasional weekends may be required as needed

Preferred Qualifications: 

• 1 years of Pharmacy work experience in retail, community pharmacy, or Pharmacy Benefit Management 
• Call center experience

Soft Skills:

• Demonstrates interpersonal, consultative, and problem-solving skills - Ability to ask questions to understand patient needs while having empathy and actively listening
• Solid telephonic skills - Ability to speak clearly and communicate with senior citizens and healthcare professionals
• Capable of defusing conflict appropriately with solid conflict management skills 
• Commitment to professionalism and a dedicated desire to advance patient care 
• Ability to interact cross functionally within the organization
• Excellent attention to detail, time management, organizational, and prioritization skills and ability to balance multiple priorities

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.    

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

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