Top 54494 Comprehensive Pharmacy Service Jobs

RN Clinical Reviewer (CPC Medical Coding Academy) - San Juan, PR
UnitedHealth Group —San Juan, PR
- Full-time
- RN License
- Pass drug screening
- Research
Director - Pharmacy Network Contracting & Public Payer Relations
Hemophilia Alliance —Remote
- $130,000 - $170,000 a year
- Full-time
- Background check
- Up to 50% travel
- 5 years
- Health savings account
- Health insurance
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Pharmacy Technician (Infusion) - $2000 Sign On Bonus
The Cancer & Hematology Centers —Grand Rapids, MI
- Full-time
- OSHA
- High school diploma or GED
- Math
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12d
Pharmacy Technician - $2000 Sign On Bonus Available!
The Cancer & Hematology Centers —Lansing, MI
- Full-time
- OSHA
- High school diploma or GED
- Math
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12d
Regional Account Liaison - BioPlus Specialty Infusion- Ohio
Elevance Health —Columbus, OH
- $95,040 - $142,560 a year
- 6 years
- Bachelor of Science
- Mid-level
- Employee stock purchase plan
- Paid holidays
Pharmacy Care Technician - Work From Home (Idaho)
CVS Health —Idaho
- $17.00 - $25.65 an hour
- Online Application
- Remote
- Computer literacy
- Windows
- High school diploma or GED
- Paid holidays
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Centralized Order Entry Manager - Work From Home
Work from Home —Nashville, TN
- Full-time
- Remote
- Bachelor of Science
- Mid-level
- 1 year
- Employee stock purchase plan
- Disability insurance
Quick Apply
2d
Mail Order Pharmacy Technician
Centerwell —Arizona
- $40,000 - $52,300 a year
- Full-time
- Remote
- Customer service
- Mid-level
- High school diploma or GED
- Paid parental leave
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Pharmacist
McKenzie Health —Watford City, ND
- Full-time
- Management
- Inpatient
- Outpatient experience
- 403(b) matching
- Loan repayment program
Quick Apply
Director of Health Services (RN)
MBK Senior Living —Klamath Falls, OR
- $100,000 - $120,000 a year
- Full-time
- Nursing
- Current TB test
- LVN
- Wellness program
- Health insurance
Quick Apply
Full-Time Physical Therapist: One-Hour Visits. No Double Booking. $10,000 Sign On Bonus
F.W. Huston Medical Center —Winchester, KS
- $45 - $60 an hour
- Part-time
- Background check
- Hospital
- Physical & Rehabilitation Medicine
- Continuing education credits
- Disability insurance
Quick Apply
4d
Pharmacist
Ho-Chunk, Inc. —Tsaile, AZ
- Overtime
- Current TB test
- PALS Certification
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11d
Pharmacist
PharMerica —Asheville, NC
- Full-time
- Mid-level
- Bachelor's degree
- Leadership
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Market Physician Executive (MPE) - Atlanta, GA
Monogram Health Professional Services —Atlanta, GA
- On call
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- Critical & Intensive Care
- Travel
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Market Physician Executive (MPE)
Monogram Health Professional Services —Valdosta, GA
- On call
- Hybrid work
- Medicine
- Critical & Intensive Care
- Travel
- Paid parental leave
- Paid holidays
Quick Apply
Market Physician Executive (MPE)
Monogram Health Professional Services —Brunswick, GA
- On call
- Hybrid work
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- Paid parental leave
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Pharmacist
Flatwater Group —Tsaile, AZ
- Overtime
- Current TB test
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11d
Pharmacist - Per Diem (PRN) - Heartland Health Center Pharmacy
Maxor National Pharmacy Services, LLC —Grand Island, NE
- $65 - $66 an hour
- Monday to Friday
- Spanish
- Management
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Pharmacist
Pharmacy First Health —Phillips, WI
- $60 - $70 an hour
- Full-time
- Bachelor of Science
- Mid-level
- Bachelor's degree
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Nurse Practitioner/Physician Assistant
Monogram Health Professional Services —Madison, GA
- Weekends as needed
- Skilled nursing facility
- RN License
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- Mileage reimbursement
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RN Clinical Reviewer (CPC Medical Coding Academy) - San Juan, PR

UnitedHealth Group -
San Juan, PR

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Job Details

Full-time

Qualifications

Foreign language proficiency
RN License
Productivity software

Full Job Description

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 diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

Positions in this function investigates Optum Waste and Error stopped claims by gathering information, researching state and federal guidelines, and following internal procedure to determine the viability of the claim for further review in a production environment.

Primary Responsibilities:

Clinical Case Reviews -75%
- Perform clinical review of professional (or facility) claims vs. medical records to determine if the claim is supported or unsupported
- Maintain standards for productivity and accuracy. Standards are defined by the department
- Provide clear and concise clinical logic to the providers when necessary
- Examine, assess, and document business operations and procedures to ensure data integrity, data security and process optimization
- Investigate, recover, and resolve all types of claims as well as recovery and resolution for health plans, commercial customers, and government entities
- Investigate and pursue recoveries
- Ensure adherence to state and federal compliance policies, reimbursement policies, and contract compliance
- Use pertinent data and facts to identify and solve a range of problems within area of expertise
- Other internal customer correspondence and team needs - 15%
- Attend and provide feedback during monthly meetings with assigned internal customer department
- Provide continuous feedback on how to improve the department relationships with internal team members and departments
Continuing education - 10%
- Keep up required Coding Certificate and/or Nursing Licensure
- Complete compliance hours as required by the department

***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:

Coding Certificate or Nursing Licensure, for example:
Puerto Rico Registered Nurse
Certified Professional Coder (CPC) + CPC A
Certified Inpatient Coder (CIC)
Certified Outpatient Auditor (COC)
Certified Professional Medical Auditor (CPMA)
Certified Coding Specialist (CCS)
Demonstrated proficiency with computers, including Microsoft Suite of products
Ability to observe an on-site work model
Willing or able to work from Monday to Friday, 40 hours per week during our business operating hours of 8am - 7pm ATL
Professional proficiency in both English and Spanish (Please note that an English proficiency assessment will be required for this position)

Preferred Qualifications:

Experience working with medical claims platforms
Medical record coding experience with experience in Evaluation and Management Services in the outpatient/office setting
Presentation or policy documentation experience
Proven knowledge of CMS and AMA coding rules specific to CPT, HCPCS
Proven knowledge of CMS Coverage, Federal and State Statues, Rules and Regulations
Proven knowledge of Medicaid/Medicare Reimbursement methodologies
Proven working knowledge of the healthcare insurance/managed care industry
Proven working knowledge of medical terminology and claim coding

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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