Pharmacist Appeals

@ UnitedHealthcare

About the Pharmacist Appeals Role

At UnitedHealthcare, we are simplifying the health care experience, creating healthier communities and removing barriers to quality care. In this role as Pharmacist Appeals, you will impact millions of lives by evaluating prescriptions, patient histories, and appeal requests while working remotely from anywhere in the U.S.

Primary Responsibilities

• Evaluate prescriptions and patient histories.
• Interpret physician orders and clinical documentation.
• Consult with customers, patients, and physicians regarding medication use and appeal requests.
• Conduct quality assurance and verify prescription accuracy.
• Review formulary and utilization management guidelines to determine benefits.
• Gather clinical information and consult with medical directors when needed.
• Answer queries regarding prescription drugs.

Benefits & Perks

Competitive base pay, a comprehensive benefits package including paid time off, health, dental, vision, life insurance, 401(k), education reimbursement, employee discounts, referral bonuses and more. Enjoy the flexibility of a remote position and a supportive management team committed to your success.

Required Qualifications

• Bachelor's Degree (or higher) in Pharmacy or Pharm D.
• Active, unrestricted Pharmacist license in the state of residence.
• 1+ years of licensed Pharmacist experience.
• Experience with online clinical references and digital document images.
• Experience in Coverage Determinations or member appeals.
• Proficiency in MS Office and Windows based systems.
• Ability to work on a rotating schedule and provide on-call Sunday coverage.

Preferred Qualifications

• Pharm D degree and Pharmacy Residency experience.
• Experience in PBM, Medicaid, Commercial, or Medicare Part D plans.
• Experience with pharmacy reimbursement processes.
• Excellent written and verbal communication skills.
• Adherence to UnitedHealth Group's Telecommuter Policy for remote employees.

Equal Opportunity & Additional Information

UnitedHealthcare is an Equal Employment Opportunity employer. We encourage qualified applicants regardless of race, gender, age, or other protected characteristics. This role is a drug-free workplace and requires passing a drug test. Applications will be considered in compliance with the San Francisco Fair Chance Ordinance.

Key skills/competency

• Prescription Evaluation
• Clinical Documentation
• Appeals Processing
• Quality Assurance
• Regulatory Compliance
• Formulary Review
• Consultation
• Record Keeping
• Telecommuting
• MS Office