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Pharmacy Compliance Auditor

Company: UnitedHealth Group
Location: Boise
Posted on: January 27, 2023

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. Come make an impact on the communities we serve as we help advance health equity on a global scale. Here, you will find talented peers, comprehensive benefits, a culture guided by diversity and inclusion, career growth opportunities and your life's best work.(sm)

The Regulatory Adherence Analyst (i.e. Pharmacy Compliance Audit Team Auditor ("PCAT Auditor") conducts on-site, pharmacy compliance audits and helps to ensure regulatory, compliance, and accreditation requirements are met at Optum Rx (ORx) pharmacies. PCAT audits ORx retail/client retail, home delivery, and specialty pharmacies and completes approximately 12-16 audits per month.

If you reside in Idaho, Oregon, Washington, or Arizona, you will enjoy the flexibility to telecommute as you take on some tough challenges.

Primary Responsibilities:

  • Conduct on-site and virtual based regulatory compliance-based internal audits within Optum Rx
  • Manage and prioritize assigned audits to meet mandated turnaround times
  • Ensure compliance with applicable laws and regulations (e.g., DEA, state-specific regulations, CMS, and HIPAA)
  • Demonstrate knowledge of applicable medical/pharmacy terminology (e.g., CPT, ICD-9, ICD-10)
  • Adhere to applicable internal business processes/guidelines/requirements to perform and track audit status
  • Lead department level activities and initiatives
  • Work with business partners to identify and improve pharmacy compliance related issues
    What are the reasons to consider working for UnitedHealth Group? Put it all together - competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:
    • Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
    • Medical Plan options along with participation in a Health Spending Account or a Health Saving account
    • Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage
    • 401(k) Savings Plan, Employee Stock Purchase Plan
    • Education Reimbursement
    • Employee Discounts
    • Employee Assistance Program
    • Employee Referral Bonus Program
    • Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)
    • More information can be downloaded at:
      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:
      • High School Diploma/GED (or higher) OR 5+ years of experience auditing pharmacies
      • National Pharmacy Technician Certification
      • 3+ years of relevant work experience in the healthcare industry
      • Home location within 45 miles of an International Airport
      • Reside in the state of Arizona, Idaho, Washington, or Oregon
      • Ability to travel by plane, train, and car for timeframe up to 8 hours
        Preferred Qualifications:
        • Certified Quality Auditor (CQA) or equivalent credential(s)
        • 1+ year of experience conducting or assisting with quality, compliance, or internal audit
        • 1+ year of previous Quality experience or demonstrated Subject Matter Expert across multiple quality areas
        • Intermediate level of proficiency using MS Excel (filtering and sorting data)
          Physical Requirements and Work Environment:
          • Extended periods of sitting at a computer and use of hands/fingers across keyboard or mouse
          • Extended periods of standing, bending, twisting at a pharmacy location
            To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state, and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.

            Careers with Optum. Our objective is to make health care simpler and more effective for everyone. With our hands at work across all aspects of health, you can play a role in creating a healthier world, one insight, one connection and one person at a time. We bring together some of the greatest minds and ideas to take health care to its fullest potential, promoting health equity and accessibility. Work with diverse, engaged and high-performing teams to help solve important challenges.

            All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.

            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.

            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: UnitedHealth Group, Boise , Pharmacy Compliance Auditor, Other , Boise, Idaho

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