Remote PA Pharmacist – Appeals & Review

NHSHP; 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) Savings Plan

Education Reimbursement

Employee Discounts

Job summary

UnitedHealth Group is hiring a Pharmacist PA/Appeals to support clinical review of prior authorization and appeals. This remote role serves Vermont and Maine residents, with a schedule of 8-hour shifts between 8am-8pm EST, and on-call weekends as needed.

The candidate will analyze requests, apply clinical criteria, document actions, and coordinate with providers and internal teams to ensure timely, accurate determinations while maintaining HIPAA compliance.

Qualifications

• Pharmacist degree (B.Pharm or PharmD) and an active license in good standing.
• Experience with prior authorization processes and appeals is preferred.
• Proficiency with Microsoft Office and basic systems for documentation.

Responsibilities

• Review, decide, and process prior authorization and appeals using clinical criteria and plan rules.
• Research medication information and verify benefit details across systems.
• Communicate case status and next steps to providers, members, and teams.
• Document rationale, actions, and outcomes in the case management tools.
• Protect PHI and ensure compliance with HIPAA and privacy requirements.

Skills

Strong communication

Attention to detail

Clinical judgment

Time management

Education

Bachelor or Doctor of Pharmacy

Tools

Excel

Word

Outlook

Teams

Job description

UnitedHealth Group is hiring a Pharmacist PA/Appeals to support clinical review of prior authorization and appeals. This remote role serves Vermont and Maine residents, with a schedule of 8-hour shifts between 8am-8pm EST, and on-call weekends as needed.

The candidate will analyze requests, apply clinical criteria, document actions, and coordinate with providers and internal teams to ensure timely, accurate determinations while maintaining HIPAA compliance.