Remote Pharmacist PA/Appeals (VT & ME)

Sacbar; Portland (ME); Remote; USD 62,000 - 109,000; Full time

Benefits offered by this job

Health plan options

Dental, Vision, Life & AD&D Insurance

Paid time off and holidays

Job summary

UnitedHealth Group is seeking a Pharmacist PA/Appeals to support clinical review, decisioning, and communication for pharmacy prior authorizations and appeals. This remote role covers Maine and Vermont, with a schedule M-F, 8:00 AM–8:00 PM EST and potential on-call weekends.

The ideal candidate has a PharmD, active license, and experience applying benefit criteria and HIPAA privacy standards to ensure compliant determinations.

Qualifications

• Pharmacist degree from an accredited program and an active license.
• State of residence license in good standing and CE requirements.
• Flexibility to work 8:00 AM–8:00 PM window, with on-call as needed.

Responsibilities

• Review prior authorization and appeal requests using clinical criteria and guidelines.
• Research medication information and document actions across multiple systems.
• Communicate with members, providers, and internal teams to resolve inquiries.
• Document rationale and ensure timely, compliant determinations in systems.

Skills

Verbal and written communication

Shift flexibility

HIPAA/privacy awareness

Education

Doctor of Pharmacy (PharmD)

Active pharmacist license

Unrestricted pharmacist license in state of residence

Tools

Microsoft Excel

Job description

UnitedHealth Group is seeking a Pharmacist PA/Appeals to support clinical review, decisioning, and communication for pharmacy prior authorizations and appeals. This remote role covers Maine and Vermont, with a schedule M-F, 8:00 AM–8:00 PM EST and potential on-call weekends.

The ideal candidate has a PharmD, active license, and experience applying benefit criteria and HIPAA privacy standards to ensure compliant determinations.