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PA Appeals Pharmacist Lead - Remote

  • Job
    Full-time
    Junior Level
  • Legal
    Healthcare
  • Charlotte
    Remote

AI generated summary

  • You must have an active pharmacist license, 2+ years of pharmacy experience, knowledge of online clinical resources, and experience with prior authorizations or member appeals. Proficiency in MS Office is needed.
  • You will evaluate prescriptions, consult on medication use, verify accuracy, review coverage guidelines, gather clinical info, and answer questions, ensuring thorough documentation and communication.

Requirements

  • Active, unrestricted Pharmacist license
  • 2+ years of experience as a licensed Pharmacist
  • Experience using online clinical references and accessing professional (clinical and regulatory) internet sites
  • Experience working with onscreen document images
  • Experience in Coverage Determinations (prior authorization) or member appeals
  • Intermediate computer proficiency with MS Office and must have the ability to navigate a Windows based environment
  • Ability to adhere to a M-F 8-5 PM or 9-6 PM local time with rotating weekends and holidays

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 beneficiaries 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

FAQs

Do we support remote work?

Yes, this position allows for remote work from anywhere within the U.S.

What are the main responsibilities of the PA Appeals Pharmacist Lead?

The primary responsibilities include evaluating prescriptions and patient histories, consulting with customers and physicians, conducting quality assurance, reviewing formulary and utilization management guidelines, and making determinations on pharmacy coverage decisions based on clinical information.

What qualifications are required for this position?

The required qualifications include an active, unrestricted Pharmacist license, 2+ years of experience as a licensed Pharmacist, experience in Coverage Determinations or member appeals, and intermediate computer proficiency.

Is a Pharm D preferred for this role?

Yes, a Pharm D is listed as a preferred qualification for this position.

What work hours are expected for this role?

The position requires adherence to a schedule of M-F 8-5 PM or 9-6 PM local time, with rotating weekends and holidays.

What benefits does UnitedHealth Group offer?

UnitedHealth Group offers a comprehensive benefits package, including incentive and recognition programs, equity stock purchase options, and 401k contributions, among others.

Is prior experience in pharmacy benefit management (PBM) beneficial for this role?

Yes, experience in PBM is listed as a preferred qualification for this position.

Will employees be required to pass a drug test?

Yes, candidates are required to pass a drug test before beginning employment.

What is the hourly pay range for this role?

The hourly pay range for this role is $42.31 to $83.27 per hour, based on several factors including local labor markets and experience.

Does this position involve working with Medicaid or Medicare plans?

Yes, experience in Medicaid, Commercial (private), and/or Medicare Part D prescription drug plans is preferred for this role.

Science & Healthcare
Industry
10,001+
Employees

Mission & Purpose

When it comes to your health, everything matters. That’s why UnitedHealthcare is helping people live healthier lives and making the health system work better for everyone. Our health plans are there for you in moments big and small, delivering a simple experience, affordable coverage, and supportive care. Wherever your health takes you, we're there for what matters. At UnitedHealthcare, part of the UnitedHealth Group family of businesses, we are working to create a system that is connected, aligned and more affordable for all involved; one that delivers high quality care, responsive to the needs of each person and the communities in which they live. With connections to more than 1.3 million physicians and care professionals and 6,500 hospitals and care facilities across the globe, we can collaborate in new ways to improve patient care while providing customizable and comprehensive solutions in any marketplace, anywhere.

Culture & Values

  • Integrity

    Honor commitments. Never compromise ethics.

  • Compassion

    Walk in the shoes of the people we serve and those with whom we work.

  • Relationships

    Build trust through collaboration.

  • Innovation

    Invent the future. Learn from the past

  • Performance

    Demonstrate excellence in everything we do.

Benefits

  • United Well-being

    United Well-being supports employees in their journey to better health. Resources include: Exercise and mindfulness apps. Tips and recipes for healthy cooking. Wellness coaching and financial tools. A private employee community group.

  • Health and Insurance

    Our medical plans for employees deliver better value and better outcomes. We offer: Copay plans and HSA-eligible plans. Vision and dental plans. Flexible spending accounts. Life insurance, and more.

  • Savings and Retirement

    In addition to competitive pay, we provide financial benefits to help employees manage their money. Benefits include: 401(k) Savings Plan. Employee Stock Purchase Plan. UnitedHealth Group credit union, and more.

  • Paid Time Off (PTO)

  • Paid Company Holidays

  • Parental Leave

  • Employee Assistance Program