PA Appeals Pharmacist Lead - Remote
Company: UnitedHealth Group
Location: Charlotte
Posted on: February 11, 2025
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Job Description:
At UnitedHealthcare, we're simplifying the health care
experience, creating healthier communities and removing barriers to
quality care. The work you do here impacts 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:
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
You'll be rewarded and recognized for your performance in an
environment that will challenge you and give you clear direction on
what it takes to succeed in your role as well as provide
development for other roles you may be interested in.Required
Qualifications:
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
Preferred Qualifications:
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
*All employees working remotely will be required to adhere to
UnitedHealth Group's Telecommuter Policy
California, Colorado, Connecticut, Hawaii, Maryland, Nevada, New
Jersey, New York, Rhode Island, Washington, Washington, D.C.
Residents Only: The hourly range for this role is $42.31 to $83.27
per hour. Pay is based on several factors including but not limited
to local labor markets, education, work experience, certifications,
etc. UnitedHealth Group complies with all minimum wage laws as
applicable. In addition to your salary, UnitedHealth Group offers
benefits such as, a comprehensive benefits package, incentive and
recognition programs, equity stock purchase and 401k contribution
(all benefits are subject to eligibility requirements). No matter
where or when you begin a career with UnitedHealth Group, you'll
find a far-reaching choice of benefits and incentives.
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 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.
Diversity creates a healthier atmosphere: UnitedHealth Group is an
Equal Employment Opportunity/Affirmative Action employer and all
qualified applicants will receive consideration for employment
without regard to race, color, religion, sex, age, national origin,
protected veteran status, disability status, sexual orientation,
gender identity or expression, marital status, genetic information,
or any other characteristic protected by law.
UnitedHealth Group is a drug-free workplace. Candidates are
required to pass a drug test before beginning employment.
Keywords: UnitedHealth Group, Charlotte , PA Appeals Pharmacist Lead - Remote, Healthcare , Charlotte, North Carolina
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