Pharmacist PA/Appeals

Sacbar; Cheyenne (WY); Hybrid; USD 61,000 - 109,000; Full time

Benefits offered by this job

Medical plan options

Dental, Vision, Life Insurance

401(k) plan

Job summary

UnitedHealth Group is seeking a Senior Pharmacy PA/Appeals Technician in Wyoming. The role handles prior authorizations, reviews clinical criteria, and supports efficient, compliant decision making to improve patient access to medications.

The position requires Pharm.D. or PharmD-equivalent, Wyoming license, and strong computer skills. Eligible for remote work within Wyoming with flexible hours and potential OT.

Qualifications

• Pharm.D. degree or Bachelor's degree in Pharmacy.
• Active and unrestricted Pharmacist license in Wyoming
• Solid drug product and clinical pharmacy knowledge
• Ability to work independently with minimal supervision
• Clinical ability to interpret criteria for prior authorization
• Proficient computer skills: Excel, Word, Outlook, SharePoint
• Primary residence in Wyoming

Responsibilities

• Process incoming requests for prior authorizations via fax or phone.
• Perform clinical reviews per legal and contractual requirements.
• Maintain productivity and quality targets.
• Document all interactions per regulatory and contractual requirements.
• Collaborate with providers and physicians to obtain information.

Skills

Clinical pharmacy knowledge

Computer proficiency (Excel/Word/Outlo

Independent work

Prior Authorization experience

Education

Doctor of Pharmacy (Pharm.D.)

Bachelor's degree in Pharmacy

Tools

SharePoint

Job description

Realistic Job Preview Video

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

The essential functions of a Senior Pharmacy PA/Appeals Technician are providing expertise and customer service support to members, customers, and/or providers. This position exists to take incoming requests for prior authorizations, for formulary and non-formulary medications, while ensuring a high level of customer service and maximizing productivity. Requests can be received via fax or telephone, from providers' offices and pharmacists. The position provides clinical review for authorizations in keeping with legal and contractual requirements, including but not limited to turn around times (TATs) and service level agreements (SLAs). The technician must provide the information clearly, accurately and in a professional manner. Interactions with callers must be documented per contractual and various regulatory / legal requirements.

Position Schedule: Ability to work any shift from 7:00 AM to 7:00 PM timeframe with flexible hours, including OT

If you reside within the states of Wyoming, you will enjoy the flexibility to telecommute* as you take on some tough challenges.

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
• Didactic training is 4 weeks, followed by additional on the job training
• Shift after training is an 8-hour shift with a 30-minute lunch, unless dictated otherwise by law. Candidate must be available as early as 7:00 am and as late as 7:00pm local time
• Candidate will work 5 days a week
• There may be pre-scheduled overtime and/or working on holidays dependent on business needs
• Candidates must have access to internet that can hard wired with Ethernet cord. A business internet line will be provided upon onboarding
• Candidates must also have a secure office/workspace in their home
• Candidate must have some technical savvy when it comes to working with PC (ex. initial setup of equipment, accessing and navigating through multiple systems and screens)
• Candidate should have certain soft skills such as sitting, using hands/fingers across keyboard or mouse, long periods working at a computer, and listening using a headset
• Excellent attendance is a must throughout training and thereafter

What are the reasons to consider working for UnitedHealth Group? Put it all together - competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:

• 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.)
• More information can be downloaded at: http://uhg.hr/uhgbenefits

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required 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 (ability to create, edit, and save a basic spreadsheet), Microsoft Word (ability to create, edit, and save a basic document), and Microsoft Outlook (ability to send emails), and SharePoint
• Primary residence in the state of Wyoming

Preferred Qualifications:

• 1+ years of experience working as clinical pharmacist
• Experience working in Prior Authorization
• Experience working within a managed healthcare system
• Proven working knowledge of Medicare Part D, CMS regulations, NCQA, and State regulations

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

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). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $44 - $79 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone‑of every race, gender, sexuality, age, location, and income‑deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. 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.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.