Remote PA Pharmacist - Appeals & Prior Authorization

Texas Health Institute; Portland (ME); Remote; USD 61,000 - 109,000; Full time

Benefits offered by this job

Paid Time Off

Medical plan options

Dental Insurance

Vision Insurance

401(k) Plan

Education Reimbursement

Employee Discounts

Employee Assistance Program

Referral Bonus

Voluntary Benefits

Job summary

UnitedHealth Group is seeking a Pharmacist PA/Appeals to support remote prior authorization review and appeal decisions across Maine and Vermont. The role emphasizes clinical judgment, regulatory compliance, and timely determinations, with flexible telecommuting options.

You will collaborate with providers, members, and internal teams to resolve inquiries, document decisions, and ensure accurate processing while maintaining privacy and security standards in a fast-paced, compliant environment.

Qualifications

• Pharmacy degree and active pharmacist license.
• Current, unrestricted pharmacist license in the state of residence.
• Ability to work within 8:00 AM to 8:00 PM window, including flexibility for overtime, weekends, and on-call as required.

Responsibilities

• Review and decide on prior authorization and appeals per criteria.
• Research medication information across systems and document actions.
• Handle inbound calls to clarify requirements and provide case status.
• Apply criteria to approvals/denials and document rationale.
• Protect PHI and comply with privacy policies.
• Document call details and case actions across systems.

Skills

Communication

Attention to detail

Critical thinking

Multi-system navigation

Education

Bachelor of Pharmacy or Doctor of Pharmacy

Tools

Microsoft Excel

Microsoft Word

Microsoft Outlook

Microsoft Teams

Job description

UnitedHealth Group is seeking a Pharmacist PA/Appeals to support remote prior authorization review and appeal decisions across Maine and Vermont. The role emphasizes clinical judgment, regulatory compliance, and timely determinations, with flexible telecommuting options.

You will collaborate with providers, members, and internal teams to resolve inquiries, document decisions, and ensure accurate processing while maintaining privacy and security standards in a fast-paced, compliant environment.