Remote PA Pharmacist — Appeals & Clinical Review

UnitedHealth Group; Portland (ME); On-site; USD 61,000 - 109,000; Full time

Benefits offered by this job

Medical plan options

Dental, Vision, Life & AD&D Insurance

401(k) Savings Plan

Job summary

UnitedHealth Group is seeking a Pharmacist PA/Appeals to support clinical review and determinations for prior authorization and appeals from a remote role based in Maine or Vermont. The position emphasizes applying benefit criteria, regulatory guidelines, and established workflows to ensure timely, accurate decisions while collaborating with providers, members, and internal teams.

You will operate within a telecommuter framework, fulfilling shift coverage from 8:00 AM to 8:00 PM with on-call

Qualifications

• Pharmacist degree (DPharm/PharmD) and active license.
• Ability to work 8am-8pm window with on-call coverage.
• Residence in Maine or Vermont required.

Responsibilities

• Review and decide on prior authorization and appeals using clinical criteria and plan rules.
• Research medication details and document actions across systems for accurate case resolution.
• Explain case status to members/providers and ensure compliant turnaround times.

Skills

Excel proficiency

Attention to detail

Clinical judgment

Communication skills

Education

Doctor of Pharmacy or Bachelor of Pharmacy

Tools

Excel

Word

Outlook

Teams

Job description

UnitedHealth Group is seeking a Pharmacist PA/Appeals to support clinical review and determinations for prior authorization and appeals from a remote role based in Maine or Vermont. The position emphasizes applying benefit criteria, regulatory guidelines, and established workflows to ensure timely, accurate decisions while collaborating with providers, members, and internal teams.

You will operate within a telecommuter framework, fulfilling shift coverage from 8:00 AM to 8:00 PM with on-call