Pharmacist PA/Appeals

UnitedHealth Group; Minnetonka (MN); Teletrabalho; USD 61 000 - 109 000; Tempo integral

Resumo da oferta

UnitedHealthcare is seeking a licensed Pharmacist for a remote US role focused on evaluating prescriptions, interpreting Medical data, and processing appeals. You will consult with patients, physicians, and customers, ensure QA of prescriptions, and determine coverage decisions with adherence to guidelines.

The position emphasizes documentation and clear communication. Preferred candidates have Pharm D or residency experience and familiarity with Medicaid/Medicare plans.

Qualificações

• Active, unrestricted Pharmacist license in your state of residence.
• 4+ years of experience using online clinical references and accessing professional sites.
• 2+ years of working experience as a licensed Pharmacist.
• 1+ years of experience working with onscreen document images.
• Ability to navigate a Windows-based environment with MS Office.
• Willing to work occasional weekends/holidays and until 5pm local time.

Responsabilidades

• Evaluate prescriptions and patient histories.
• Interpret prescriptions, access clinical criteria and compendia.
• Consult with customers, patients and physicians on uses, interactions, and appeals.
• Conduct quality assurance and verify prescription accuracy for appeals.
• Provide explanations within area of expertise.
• Review formulary and utilization guidelines to determine coverage.
• Research and decide on member/provider appeals of coverage decisions.
• Gather clinical information and consult with medical directors as needed.
• Answer questions from support personnel regarding prescription drugs.
• Maintain thorough documentation and clear written/verbal communication.

Conhecimentos

Clinical references usage

Licensed Pharmacist experience

Document image handling

MS Office proficiency

Weekend/holiday availability

Evening hours availability

Formação académica

Pharmacist license

Descrição da oferta de emprego

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 startCaring. Connecting. Growing together.

You'll enjoy the flexibility to work remotely * 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
• Position requires excellent record keeping skills, thorough documentation, clear and concise written/verbal communications skills

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:

• Active, unrestricted Pharmacist license in your state of residence
• 4+ years of experience using online clinical references and accessing professional (clinical and regulatory) internet sites
• 2+ years of working experience as a licensed Pharmacist
• 1+ years of experience working with onscreen document images
• Intermediate level of computer proficiency with MS Office and the ability to navigate a Windows based environment
• Ability to work the occasional weekend and holiday (rotation through the team)
• Willing and able to work until 5pm local time

Preferred Qualifications:

• Pharm D
• 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, and Commercial
• Proven excellent written and verbal communication skills

*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 $44.00 to $79.00 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

Application Deadline:

This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

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.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

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

#RPO, #GREEN