Remote Clinical Pharmacist - Appeals & Coverage Expert

Optum; United States; Remote; USD 61,000 - 109,000; Full time

Benefits offered by this job

Comprehensive benefits package

Incentive programs

401k contribution

Job summary

UnitedHealthcare is seeking a licensed Pharmacist for a remote role across the United States. You will evaluate prescriptions, interpret clinical data, advise customers and clinicians on drug interactions and appeals, and render decisions within regulatory guidelines.

Strong documentation and communication are essential. Required are an active pharmacist license, 4+ years of reference-based clinical work, 2+ years as a licensed pharmacist, and proficiency with MS Office.

Qualifications

• Active, unrestricted Pharmacist license in your state of residence.
• 4+ years of experience using online clinical references and accessing professional 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.
• Willing and able to work until 5pm local time.

Responsibilities

• Evaluate prescriptions and patient histories.
• Interpret prescriptions and clinical documentation, access criteria and compendia support.
• Consult with customers, patients and/or physicians regarding use of medications and drug interactions.
• Conduct quality assurance and verify prescription accuracy for appeals decisions.
• Review formulary and utilization management guidelines to determine coverage.
• Research and decide on member/provider appeals of pharmacy coverage decisions.
• Gather complex clinical information and consult with Plan Medical Directors as needed.
• Answer questions from support personnel regarding prescription drugs.

Skills

Clinical judgment

Communication skills

Detail oriented

Team collaboration

Education

Pharmacist license (state)

Pharm D (preferred)

Tools

MS Office

Windows environment

Job description

UnitedHealthcare is seeking a licensed Pharmacist for a remote role across the United States. You will evaluate prescriptions, interpret clinical data, advise customers and clinicians on drug interactions and appeals, and render decisions within regulatory guidelines.

Strong documentation and communication are essential. Required are an active pharmacist license, 4+ years of reference-based clinical work, 2+ years as a licensed pharmacist, and proficiency with MS Office.