PA - Appeals Pharmacist

UnitedHealth Group • Greensboro, NC

309d • $42 - $83 • Remote

About The Position

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. Ready to make a difference? Join us to start Caring. Connecting. Growing together. You'll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.

Requirements

• Active, unrestricted Pharmacist license
• 1+ years of experience as a licensed Pharmacist
• Experience using online clinical references and accessing professional (clinical and regulatory) internet sites
• Experience working with onscreen document images
• Experience in Coverage Determinations (prior authorization) or member appeals
• Intermediate computer proficiency with MS Office and must have the ability to navigate a Windows based environment
• Ability to adhere to a Monday - Friday, alternating with Tuesday - Saturday 8-5p or 9-6p local time zone work schedule and willing to work some weekends, holidays and overtime as needed

Nice To Haves

• Pharm D
• Pharmacy Residency experience
• PBM experience
• Experience in Medicaid, Commercial (private), and/or Medicare Part D prescription drug plans, programs or formularies
• Pharmacy reimbursement (third party insurance, Medicaid)
• Proven excellent written and verbal communication skills

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
• Answer questions from support personnel regarding prescription drugs

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Industry: Insurance Carriers and Related Activities
• Education Level: Ph.D. or professional degree