UHS·Riverside, California
Provide medication adherence and utilization management support to help patients successfully manage their health. This includes performing telephonic outreach, coordinating with care teams, and managing prior authorizations within the EHR.
To perform this job successfully, an individual must be able to perform each essential function satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions Hours: 8:30am-5:30pm
(other duties may be assigned, deleted or changed at any time, at the discretion of management, formally, or informally, either verbally or in writing).
1. Telephonic and electronic outreach to patients based on internal, and payer reports, that identify those who may need additional help in managing medications and getting timely refills.
2. Coordinate with members of the patient care team, including providers, pharmacists, nurses, and patient care coordinators to address patient needs related to medication use.
3. With a strong knowledge of pharmacy workflows, insurance plans, and available resources, help patients navigate the complexities of obtaining prescription medications and refills.
4. Support the utilization management team by ensuring proper diagnosis and billing codes are input and verifying the accuracy of the dose.
5. This role will also perform provider outreach to obtain sufficient documentation for coverage determinations as necessary.
6. Enter the appropriate Rx information into the electronic health record.
7. Enter prior authorizations into EHR. If physician approves, send request in interoffice envelope to the physician office, letting them know they need to complete the authorization.
8. Clear open encounters.
9.
Exhibit a professional appearance and attitude.
Adhere to Clinic and departmental policies and procedures This opportunity offers the following: Challenging and rewarding work environment Growth and Development Opportunities within UHS and its Subsidiaries Competitive Compensation About Universal Health Services One of the nation’s largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance.
During the year, UHS was again recognized as one of the World’s Most Admired Companies by Fortune; and listed in Forbes ranking of America’s Largest Public Companies.
Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.S.
States, Washington, D.C., Puerto Rico and the United Kingdom. www.uhs.com EEO Statement All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates.
UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.
We believe that diversity and inclusion among our teammates is critical to our success.
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Requires at least one year of experience managing HEDIS/Stars medication adherence measures in a medical practice. A Pharmacy Technician license is preferred, though Medical Assistants or LVNs with two years of experience will be considered.
Market context
California pharmacy roles typically stay competitive because employers look for candidates who already hold a BS Pharmacy or Pharm.D., a valid California Pharmacist License, and current BLS and ACLS certifications. These positions can also require additional board-style certification within two years, so applicants with closely matched credentials and recent clinical experience often stand out. Review the AI-summarized requirements and benefits here to quickly confirm fit, then verify your license and certifications before applying.