Pharmacist PA/Appeals - Remote Nationwide

UnitedHealth Group•Houston, TX

13h•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. 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.

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 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

Nice To Haves

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

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
Position requires excellent record keeping skills, thorough documentation, clear and concise written/verbal communications skills