UnitedHealth Group Business Operations Specialist - Irvine, CA in Irvine, California
Position Description: Welcome to one of the toughest and most fulfilling ways to help people, including yourself.
We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement.
Join us and start doing your life's best work. We'll put you in the driver's seat on vital projects that have strategic importance to our mission of helping people lead healthier lives.
Yes, we share a mission that inspires.
We need your organizational talents and business discipline to help fuel ours.
It's the opportunity to do your life's best work.(sm)This Business Operations Specialist position is responsible for supporting accreditation efforts in Quality Management.
Support of the accreditation process includes interpreting customer needs and requirements, reviewing internal operations processes to identify risks for accreditation, certification and compliance for programs such as NCQA, URAC, ACHC, VIPPS, DMEPOS, State and Federal Regulations, etc.
Furthermore, the Business Operations Specialist will analyze report findings to contribute to corrective action plans and serve as a key resource on complex and / or critical issues.
This role will require collaboration with internal and external stakeholders to develop and achieve quality improvement. Positions in this function include those responsible for providing process and operational support to the functions within Business Operations Family.
Positions in this function may also be responsible for quality reporting, analysis and audits, and for developing plans and programs to support continuous quality improvement using applicable tools. Requirements: High School Diploma / GED 2+ years Managed care or PBM (Pharmacy experience) Basic proficiency in MS Word, Excel, Outlook and PowerPointPharmacy Claims experienceWell-rounded business knowledge including Standard Prior Authorization processKnowledge of Prior Authorization Case turnaround times (TAT)Assets: Bachelor's Degree or higherCertified Pharmacy Tech License / Certification Research experience in AS400 / RxClaim Well-rounded knowledge of the Pega or Pega Rules Process Commander (PRPC) applicationKnowledge of Center for Medicare Services (CMS) RegulationsRetail, Pharmacy or Hospital experience Knowledge of pharmacy applications IRIS and / or ScriptMedAdvanced proficiency in MS Excel and PowerPoint (Excel- formulas and calculations/ PowerPoint - creating clean and detailed slides and presentations)Previous experience communicating with different levels of leadershipKnowledge of the following organizations / accreditations: NCQA, URAC, ACHC, VIPPS, DMEPOSSoft Skills:Strong writing and documentation skills Organizational skills CreativityAbility to work with a variety of staff and disciplines at all levels throughout the organizationSystematic and qualitative problem solvingAbility to create and maintain quality reporting and tracking toolsAbility to investigate process issues through the use of dataAbility to analyze data to identify improvement opportunities and development of solutionsStrong data research and analysisExcellent verbal and written communication Professional presentationOptumRx 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.SM Diversity 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.Keywords: Business Operations Specialist, Irvine, California, PBM, accreditations, prior authorization, healthcare a895e026-edc6-4d78-bc5b-d7e767e0d148
Business Operations Specialist - Irvine, CA California-Irvine 723218