PA - Appeals Pharmacist - Remote Nationwide - #1414551
UnitedHealthcare
Date: 15 hours ago
City: Irvine, CA
Salary:
$43.22
-
$77.21
per hour
Contract type: Full time
Remote

At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts on the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.
You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities
Required Qualifications
Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to the volume of applicants.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
#RPO #GREEN
You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities
- Evaluate prescriptions and patient histories
- Interpret physicians' prescriptions and clinical documentation, accesses clinical criteria and compendia support
- Consult with customers, patients and/or physicians regarding use of medications, potential drug interactions, and clinical status for appeals requests
- Conduct Quality Assurance and verify the accuracy of all prescriptions to render appeal decision
- Provide explanations and interpretations within area of expertise
- Review formulary and utilization management guidelines to determine if the drug should be a covered benefit for the beneficiary based on their medical history
- Research, evaluate, and make determinations on member and provider appeals of pharmacy coverage decisions
- Gather complex clinical information, consider approved compendia, medical literature, coverage policy, and criteria information and work within regulatory guidelines to render decisions. Decision may require consulting with Plan Medical Directors and the beneficiary’s treating physician
- Answer questions from support personnel regarding prescription drugs
- Position requires excellent record keeping skills, thorough documentation, clear and concise written/verbal communications skills
- Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
- Medical Plan options along with participation in a Health Spending Account or a Health Saving account
- Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage
- 401(k) Savings Plan, Employee Stock Purchase Plan
- Education Reimbursement
- Employee Discounts
- Employee Assistance Program
- Employee Referral Bonus Program
- Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)
- More information can be downloaded at: http://uhg.hr/uhgbenefits
Required Qualifications
- Active, unrestricted Pharmacist license in the state of residence
- 1+ years of experience as a licensed Pharmacist
- 1+ years of experience using online clinical references and accessing professional (clinical and regulatory) internet sites
- 1+ years of experience working with onscreen document images
- Intermediate level of computer proficiency with MS Office and must have the ability to navigate a Windows based environment
- Ability to adhere to a Monday - Friday, alternating with Tuesday - Saturday 8-5 PM or 9-6 PM local time zone work schedule and willing to work some weekends, holidays and overtime as needed
- Pharm D
- Pharmacy Residency experience
- PBM experience
- Experience in Medicaid, Commercial (private), and/or Medicare Part D prescription drug plans, programs or formularies
- Pharmacy reimbursement (third party insurance, Medicaid)
- Proven excellent written and verbal communication skills
- Experience in Coverage Determinations (prior authorization) or member appeals
- All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to the volume of applicants.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
#RPO #GREEN
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