Remote PA Pharmacist — Appeals & Clinical Review

Sarasota Memorial Hospital; Portland (ME); Remote; USD 92,000 - 164,000; Full time

Benefits offered by this job

PTO and holidays

Medical insurance

Dental & Vision coverage

401(k) plan

Job summary

UnitedHealth Group is seeking a Pharmacist PA/Appeals for remote work in Vermont and Maine. The role focuses on clinical review, documentation, and timely determinations for prior authorizations and appeals, with collaboration across providers and internal teams.

Candidates must hold an active pharmacist license and work within an 8:00 AM–8:00 PM window, with on-call responsibilities and potential overtime. Telecommuting is available for residents of ME or VT.

Qualifications

• Pharmacist degree and active license in the state of residence.
• Knowledge of clinical criteria, benefit plans, and regulatory guidelines.
• Ability to work flexible hours including evenings, weekends, and on-call shifts.

Responsibilities

• Review, decide, and process prior authorization and appeals per criteria.
• Navigate multiple systems and document actions for case resolution.
• Explain case status and follow up with providers, members, and partners.

Skills

Pharmacist license

Clinical judgment

Excel proficiency

Communication skills

Education

Bachelor of Pharmacy or Doctor of Pharmacy

Tools

Microsoft Excel

Job description

UnitedHealth Group is seeking a Pharmacist PA/Appeals for remote work in Vermont and Maine. The role focuses on clinical review, documentation, and timely determinations for prior authorizations and appeals, with collaboration across providers and internal teams.

Candidates must hold an active pharmacist license and work within an 8:00 AM–8:00 PM window, with on-call responsibilities and potential overtime. Telecommuting is available for residents of ME or VT.