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.

The Pharmacist Process Auditor is responsible for monitoring, evaluating, and improving the quality and compliance of MTM Call Center Clinicians process. This role ensures adherence to regulatory standards, internal policies, and client requirements while driving continuous improvement.

In addition to audit responsibilities, the auditor are required to handle live calls during business-critical situations and periodically take calls to maintain process proficiency and subject matter expertise.

Primary Responsibilities:

• Monitor and evaluate calls using predefined quality frameworks.
• Assess compliance with:
  • HIPAA and healthcare regulations
  • Client-specific guidelines
  • Standard operating procedures (SOPs)
• Identify performance gaps, trends, and risks in call handling.
• Provide detailed and objective audit feedback with documentation.
• Ensure all interactions meet regulatory and privacy requirements.
• Flag critical errors, compliance risks, and potential audit failures.
• Partner with operations and compliance teams to implement corrective actions.
• Document structured audit feedback to improve performance.
• Support calibration sessions with stakeholders to ensure scoring alignment.
• Assist in training and upskilling initiatives for the operations team.
• Analyze audit data to identify trends and recurring issues.
• Propose improvements to scripts, workflows, and processes.
• Contribute to continuous improvement and quality enhancement initiatives.
• Handle inbound/outbound MTM pharmacy calls during business needs (e.g., high call volume, staffing shortages).
• Take calls periodically (e.g., once in a while) to:
  • Maintain process knowledge and expertise
  • Stay updated on call flow changes and challenges
• Ensure call handling meets the same quality and compliance standards expected of operations agents.
• Maintain accurate audit records and evaluation reports.
• Prepare and share quality performance dashboards and insights.
• Support internal and client audits by providing required documentation and analysis.

***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:

• Active, Pharmacist license in Puerto Rico
• 1+ years of experience working independently within a cross functional team environment, self-directed with excellent organizational skills
• Solid knowledge of drug products and clinical pharmacy
• Solid knowledge of healthcare compliance (HIPAA)
• Computer proficiency, including the use of Microsoft office applications
• Ability to work a flexible schedule with rotating shifts between the hours of 8:00 AM and 8:00 PM CST, Monday through Friday. Extended hours and occasional weekends may be required as needed
• Proven excellent listening, analytical, and evaluation skills
• Proven effective communication and coaching abilities
• Proven attention to detail and high level of accuracy
• Proven ability to balance audit responsibilities with occasional call handling
• Proven solid English communication skills (written and verbal)

Preferred Qualifications:

• 1+ years Pharmacy work experience in retail, community pharmacy, or Pharmacy Benefit Management
• Call center experience
• Experience in Quality Assurance / Auditing role

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.

Requisition #: 2366142

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Requirements