Pharmacist PA/Appeals - Remote Nationwide

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable.

Schedule

• Monday-Friday alternating with Tuesday-Saturday every other week
• 8 AM-5 PM or 9 AM-6 PM in the local time zone
• Some holidays and overtime as needed
• Telecommute from anywhere within the U.S.

Responsibilities

• Evaluate prescriptions and patient histories
• Interpret physicians' prescriptions and clinical documentation, access 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 decisions
• 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; may require consulting with Plan Medical Directors and the beneficiaries' treating physicians
• Answer questions from support personnel regarding prescription drugs
• Maintain excellent record-keeping skills, thorough documentation, and clear and concise written/verbal communication skills

Requirements

• 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 prior authorization case review and 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 the work schedule

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)

Pay

The hourly pay for this role will range from $44 - $79 per hour based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, and certifications.

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution (all benefits are subject to eligibility requirements)