UM Operations: Pharmacy Technician

At Devoted Health, we’re on a mission to dramatically improve the health and well-being of older Americans by caring for every person like family. That’s why we’re gathering smart, diverse, and big-hearted people to create a new kind of all-in-one healthcare company — one that combines compassion, health insurance, clinical care, service, and technology - to deliver a complete and integrated healthcare solution that delivers high quality care that everyone would want for someone they love. Founded in 2017, we've grown fast and now serve members across the United States.  And we've just started. So join us on this mission!

Job Description

This role is fully remote and must be located within one of the contiguous 50 states. 

A bit about this role:

As a Utilization Management (UM) Auditor, you'll be responsible for but not limited to: Regulatory, accreditation and operational audits across the UM teams and UM delegates. Analyze the results of those audits and provide recommendations to improve the overall quality and compliance adherence across the UM teams. Develop, implement and maintain Standard Operating Procedures (SOPs), Job Aids, and audit tools.

Required skills and experience:

• 3 years experience working as an independent contributor

• 3-5 years experience managing teams (lead,  supervisor, or manager experience)

• 3 years experience at a payer working in UM (Part B Drug and Part C) and/or audit operations

• National CPhT certification 

• Cross department collaboration with Pharmacy and Medical UM teams.

• Develops, maintains, and implements quality audit reviews for all of UM and UM delegates.

• Utilizes audit tools to perform documentation audits on job functions within UM.

• Prepares a summary report of each audit including any trends and process improvement suggestions to increase overall adherence to UM process and regulatory guidance.

Desired skills and experience:

• 3+ years in health plan operations (Medicare preferred)

• Experience processing organization determinations for Part B Drugs (a plus)

• The ability to be an independent contributor

Your Responsibilities and Impact will include:

• Ensure compliance with CMS regulatory requirements in UM and support the quality measures for applicable programs.

• Develops audit tools and conducts audits as assigned to assist in management’s documentation of compliance with regulatory, accreditation and operational process improvement standards.

• Examines and compares records and processes with required standards for accuracy and completeness in meeting currently established regulatory, accreditation and/or operational process improvement project standards. Assists in the review of new regulatory and accreditation standards on an annual or as needed basis.

• Prepare summary of audit findings with appropriate notification to management of issues in a concise and well-documented format, with a gap analysis as appropriate and proposed action plans for improvement.

• Conducts follow-up reviews to assess and verify effectiveness of any implemented action plans.

• Communicates significant audit findings to management in a timely manner following the completion of audit tasks. Prepares and submits documentation of required follow-up reviews on previous audit results in a timely manner.

• Maintains technical proficiency and remains current with the latest developments, advancements and trends in utilization management compliance.

Salary Range:  $54,000 - $77,000 / year

Our ranges are purposefully broad to allow for growth within the role over time. Once the interview process begins, your talent partner will provide additional information on the compensation for the role, along with additional information on our total rewards package. The actual base salary offered may depend on a variety of factors, including the qualifications of the individual applicant for the position, years of relevant experience, specific and unique skills, level of education attained, certifications or other professional licenses held, and the location in which the applicant lives and/or from which they will be performing the job.

Our Total Rewards package includes:

• Employer sponsored health, dental and vision plan with low or no premium

• Generous paid time off

• $100 monthly mobile or internet stipend

• Stock options for all employees

• Bonus eligibility for all roles excluding Director and above; Commission eligibility for Sales roles

• Parental leave program

• 401K program

• And more....

*Our total rewards package is for full time employees only. Intern and Contract positions are not eligible.

Healthcare equality is at the center of Devoted’s mission to treat our members like family.  We are committed to a diverse and vibrant workforce. 

Devoted is an equal opportunity employer. We are committed to a safe and supportive work environment in which all employees have the opportunity to participate and contribute to the success of the business. We value diversity and collaboration. Individuals are respected for their skills, experience, and unique perspectives. This commitment is embodied in Devoted’s Code of Conduct, our company values and the way we do business.

As an Equal Opportunity Employer, the Company does not discriminate on the basis of race, color, religion, sex, pregnancy status, marital status, national origin, disability, age, sexual orientation, veteran status, genetic information, gender identity, gender expression, or any other factor prohibited by law. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.