Job details
Job type full-time
Full job description
As one of the largest pharmacy benefits managers in the united states, unitedhealth group provides a professional culture where you`re empowered and encouraged to exceed the expectations of our members, with better schedules than retail and more reach than any hospitalJoin us and start doing your life`s best work.(sm)
You’ll enjoy the flexibility to telecommute* from anywhere within the u.sAs you take on some tough challenges.
Primary responsibilities:
As an appeals pharmacist, you will:
Interpret physicians` 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
Process pharmacy appeals, interpreting member and provider submitted clinical information, and researching clinical issues and assessing appropriateness
Organizes workload, sets priorities, completes assignments in a timely manner and utilizes resources appropriately while complying with department program standards
Performs all duties and functions in compliance with state and federal pharmacy laws and regulations
Conforms with and supports department quality assurance and improvement guidelines
Position requires excellent record keeping skills, thorough documentation, clear and concise written/verbal communications skills
Must be available to work weekend rotations
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 in respected state
2+ years of experience in medicare part d prescription drug plans, programs or formularies included in q1
2+ years of experience using online clinical references and accessing professional (clinical and regulatory) internet sites
Experience working with onscreen document images
Intermediate computer proficiency with ms office and with the ability to navigate a windows based environment
Preferred qualifications:
Pharmacy residency experience
Pbm experience
Experience in coverage determinations (prior authorization) or member appeals
Excellent written and verbal communication skills
Unitedhealth group requires all new hires and employees to report their covid-19 vaccination status.
Careers with unitedhealthcareLet`s talk about opportunityStart with a fortune 5 organization that`s serving more than 85 million people already and building the industry`s singular reputation for bold ideas and impeccable executionNow, add your energy, your passion for excellence, your near-obsession with driving change for the betterGet the picture? unitedhealthcare is serving employers and individuals, states and communities, military families and veterans where ever they`re found across the globeWe bring them the resources of an industry leader and a commitment to improve their lives that`s second to noneThis is no small opportunityIt`s where you can do your life`s best work.(sm)
Colorado residents only: the salary range for colorado residents is $79,700 to $142,600Pay is based on several factors including but not limited to education, work experience, certifications, etcIn 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.
*all telecommuters will be required to adhere to unitedhealth group’s telecommuter policy.
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 workplaceCandidates are required to pass a drug test before beginning employment.
Job keywords: health care, managed care, pharmacist, pharmacy, pharmacy appeals, telecommute, telecommuter, telecommuting, work from home, remote
