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PA - Appeals Pharmacist - Remote

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UnitedHealthcare

24d ago

  • Job
    Full-time
    Junior Level
  • Healthcare
  • Greensboro
    Remote

AI generated summary

  • You must have an active Pharmacist license, 1+ years of experience, knowledge of online clinical resources, and prior authorization experience. Proficient in MS Office and flexible with scheduling.
  • You will evaluate prescriptions, consult on medications, review appeals, ensure quality assurance, research coverage criteria, and maintain clear documentation and communication.

Requirements

  • Active, unrestricted Pharmacist license
  • 1+ 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 Monday - Friday, alternating with Tuesday - Saturday 8-5p or 9-6p local time zone work schedule and willing to work some weekends, holidays and overtime as needed

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 primary responsibilities of a PA - Appeals Pharmacist?

The primary responsibilities include evaluating prescriptions and patient histories, consulting with customers and physicians, conducting quality assurance, and making determinations on member and provider appeals regarding pharmacy coverage decisions.

What qualifications are required for this position?

Required qualifications include an active, unrestricted Pharmacist license, 1+ years of experience as a licensed Pharmacist, experience in coverage determinations or member appeals, and intermediate computer proficiency with MS Office.

Is there a preferred educational background for candidates?

Yes, a Pharm D and pharmacy residency experience are preferred, along with experience in PBM and Medicaid or Medicare Part D prescription drug plans.

What is the work schedule for this position?

The work schedule requires adherence to a Monday - Friday schedule, with alternating Tuesday - Saturday shifts from 8-5 PM or 9-6 PM local time, and willingness to work some weekends, holidays, and overtime as needed.

What is the hourly pay range for this role?

The hourly pay range for this role is $42.31 to $83.27, based on factors such as local labor markets and work experience.

What benefits does UnitedHealth Group offer?

UnitedHealth Group offers a comprehensive benefits package, including an incentive and recognition program, equity stock purchase options, and a 401k contribution, all subject to eligibility requirements.

Are there any specific requirements for remote workers?

Yes, all employees working remotely are required to adhere to UnitedHealth Group’s Telecommuter Policy.

What is the company's stance on diversity?

UnitedHealth Group is committed to being an Equal Employment Opportunity/Affirmative Action employer and values diversity, believing that everyone deserves the opportunity to live their healthiest life.

Will the successful candidate be subject to a drug test?

Yes, candidates are required to pass a drug test before beginning employment, as UnitedHealth Group is a drug-free workplace.

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UnitedHealthcare

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