Pharmacist PA/Appeals - Remote Nationwide

About the role

The work you do here impacts the lives of millions of people for the better. Join us to start Caring. Connecting. Growing together. Work Schedule: Monday-Friday alternating with Tuesday - Saturday every other week; 8AM-5PM, or 9AM-6PM in the local time zone, with some holidays and overtime as needed. You will enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities

• Evaluate prescriptions and patient histories
• Interpret physicians' prescriptions and clinical documentation, accesses clinical criteria and compendia support
• Consult with customers, patients and/or physicians regarding use of medications, potential drug interactions, and clinical status for appeals requests
• Conduct Quality Assurance and verify the accuracy of all prescriptions to render appeal decision
• Provide explanations and interpretations within area of expertise
• Review formulary and utilization management guidelines to determine if the drug should be a covered benefit for the beneficiary based on their medical history
• Research, evaluate, and make determinations on member and provider appeals of pharmacy coverage decisions
• Gather complex clinical information, consider approved compendia, medical literature, coverage policy, and criteria information and work within regulatory guidelines to render decisions. Decision may require consulting with Plan Medical Directors and the beneficiaries treating physicians
• Answer questions from support personnel regarding prescription drugs

Required Qualifications

• Master's degree in PharmD
• Active and unrestricted Pharmacist license in your state of residence
• 1+ years of experience as a licensed Pharmacist
• 1+ years of experience using online clinical references and accessing professional (clinical and regulatory) internet sites
• 1+ years of experience working with onscreen document images
• 1+ years of professional experience with business writing and communication
• 1+ years of experience of prior authorization case review & rendering PA decisions
• Intermediate level of computer proficiency with MS Office and the ability to navigate a Windows based environment
• Proven ability to adhere to a work schedule of Monday-Friday alternating with Tuesday - Saturday every other week; 8AM-5PM, or 9AM-6PM in local time zone, with some holidays and overtime as needed

Preferred Qualifications

• Pharmacy Residency experience
• PBM experience
• Experience in Medicaid, Commercial (private), and/or Medicare Part D prescription drug plans, programs, or formularies
• Experience in Coverage Determinations (prior authorization) or member appeals
• Pharmacy reimbursement (third party insurance, Medicare Part D formulary management, Medicaid

Benefits

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).

Telecommuting

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

Equal Opportunity Employer

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.

Drug-Free Workplace

Candidates are required to pass a drug test before beginning employment. #RPO #GREEN