Pharmacist PA/Appeals

Primary Responsibilities

Work is computer based, and is comprised of gathering complex clinical information, coverage policy and criteria information while working within regulatory guidelines to make coverage determinations.

Maintain minimum productivity and quality targets as dictated by the department's internal performance matrix.

Have solid attention to detail, organize workload, set priorities, complete assignments in a timely manner and utilize resources appropriately while complying with department program standards.

Certain job functions may include receiving phone calls from prior authorization pharmacy technicians and/or providers for clinical information, and consulting physicians/providers with questions.

Perform all duties and functions in compliance with state and federal pharmacy laws and regulations.

Dedication to build rapport and maintain productive working relationships with coworkers, management, internal customers, and other departments by demonstrating a solid customer service orientation and a continuous positive image of OptumRx.

Patient Safety and Quality of work is paramount and it's important for employees to have a safe and secure workspace and communicate with their leadership when that safety (equipment, system, information) is compromised.

Performs other duties and responsibilities as assigned by management.

Qualifications

• Pharm.D. degree or Bachelor's degree in Pharmacy
• Active and unrestricted Pharmacist license in good standing in the state of Wyoming
• Proven solid drug product and clinical pharmacy knowledge
• Demonstrated ability to work independently with minimal supervision
• Proven solid clinical ability to interpret criteria and implement clinical programs for prior authorization
• Proven computer and typing proficiency, including with Microsoft Excel, Microsoft Word, and Microsoft Outlook
• Primary residence in the state of Wyoming

Benefits

• 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.)