Remote Pharmacist: Appeals & Coverage Decisions

UnitedHealth Group; Minnetonka (MN); Remote; USD 61,000 - 109,000; Full time

Job summary

UnitedHealthcare is seeking a licensed Pharmacist for a remote US role focused on evaluating prescriptions, interpreting Medical data, and processing appeals. You will consult with patients, physicians, and customers, ensure QA of prescriptions, and determine coverage decisions with adherence to guidelines.

The position emphasizes documentation and clear communication. Preferred candidates have Pharm D or residency experience and familiarity with Medicaid/Medicare plans.

Qualifications

• Active, unrestricted Pharmacist license in your state of residence.
• 4+ years of experience using online clinical references and accessing professional sites.
• 2+ years of working experience as a licensed Pharmacist.
• 1+ years of experience working with onscreen document images.
• Ability to navigate a Windows-based environment with MS Office.
• Willing to work occasional weekends/holidays and until 5pm local time.

Responsibilities

• Evaluate prescriptions and patient histories.
• Interpret prescriptions, access clinical criteria and compendia.
• Consult with customers, patients and physicians on uses, interactions, and appeals.
• Conduct quality assurance and verify prescription accuracy for appeals.
• Provide explanations within area of expertise.
• Review formulary and utilization guidelines to determine coverage.
• Research and decide on member/provider appeals of coverage decisions.
• Gather clinical information and consult with medical directors as needed.
• Answer questions from support personnel regarding prescription drugs.
• Maintain thorough documentation and clear written/verbal communication.

Skills

Clinical references usage

Licensed Pharmacist experience

Document image handling

MS Office proficiency

Weekend/holiday availability

Evening hours availability

Education

Pharmacist license

Job description

UnitedHealthcare is seeking a licensed Pharmacist for a remote US role focused on evaluating prescriptions, interpreting Medical data, and processing appeals. You will consult with patients, physicians, and customers, ensure QA of prescriptions, and determine coverage decisions with adherence to guidelines.

The position emphasizes documentation and clear communication. Preferred candidates have Pharm D or residency experience and familiarity with Medicaid/Medicare plans.