Remote Pharmacist: Prior Authorization & Appeals

UnitedHealth Group; Portland (ME); Remote; Confidential; Full time

Benefits offered by this job

Paid Time Off

Medical plan options with HSA

Dental, Vision, Life & AD&D

401(k) Savings Plan

Education Reimbursement

Employee Discounts

Employee Assistance Program

Employee Referral Bonus Program

Voluntary Benefits

Job summary

UnitedHealth Group seeks a Pharmacist PA/Appeals for remote work supporting Vermont and Maine. The role focuses on clinical review, decisioning, and appeals in pharmacy prior authorization, with collaboration across providers, members, and internal teams.

Responsibilities include applying policy criteria, documenting rationale, and ensuring HIPAA compliance in a fast-paced, service-driven environment. The position offers telecommuting flexibility within Vermont and Maine and requires licensure

Qualifications

• Bachelor of Pharmacy or Doctor of Pharmacy degree from an accredited program and active pharmacist license
• Current, unrestricted pharmacist license in the state of residence with license in good standing and required CE
• Proficiency with Microsoft Office apps (Excel, Word, Outlook, Teams)
• Ability to work 8:00 AM–8:00 PM across 8 AM–8 PM window including overtime/weekends as needed
• Must reside in Maine or Vermont

Responsibilities

• Review, decision, and process prior authorization and appeals requests using established clinical criteria, benefit plan requirements, regulatory guidelines, and client instructions
• Navigate multiple computer systems and knowledge resources to research medication information and document actions
• Receive inbound calls from members, providers, pharmacies, or internal partners to clarify requirements and provide follow-up
• Apply clinical and benefit criteria to support approvals, denials, or escalation with clearly documented rationale
• Protect confidential information and ensure HIPAA compliance
• Maintain thorough documentation of call details, clinical findings, actions, and approvals/denials in systems
• Identify incomplete information or need for escalation and seek guidance from leadership
• Adapt to changing workflows and client requirements while maintaining accuracy and service standards
• Perform other duties as assigned by management

Skills

Clinical pharmacology knowledge

Strong communication skills

Attention to detail

Education

Bachelor of Pharmacy (B.Pharm)

Doctor of Pharmacy (PharmD)

Tools

Microsoft Excel

Microsoft Word

Outlook

Teams

Job description

UnitedHealth Group seeks a Pharmacist PA/Appeals for remote work supporting Vermont and Maine. The role focuses on clinical review, decisioning, and appeals in pharmacy prior authorization, with collaboration across providers, members, and internal teams.

Responsibilities include applying policy criteria, documenting rationale, and ensuring HIPAA compliance in a fast-paced, service-driven environment. The position offers telecommuting flexibility within Vermont and Maine and requires licensure