Prior Authorization Clinical Pharmacist - Full-time / Part-time

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 hospital. Join us and start doing your life's best work.(sm)

The purpose of this position is to process requests for insurance coverage of formulary and non-formulary drugs that reject at the dispensing pharmacy based on pre-determined plan criteria.  Plan criteria are setup based on evidence based medicine and includes the exercise of appropriate clinical judgment.  Prior Authorization staff pharmacists review all adverse coverage determinations before final decisions are rendered and as required by law work in conjunction with medical directors to render final decisions on coverage determinations.  This is a dynamic work environment and requires flexibility to meet business needs and adaptability to frequent changes. Teamwork is the norm and all employees will be held accountable to work as effective team members.

This position is for a Clinical Pharmacist working in the Prior Authorization unit within Customer Service department of OptumRx, a UnitedHealth Group company. 

This is a call center based business segment and strict work guidelines are employed. The pharmacist's primary role is reviewing Prior Authorization cases and rendering coverage determinations based on clinical criteria and plan design in a fast paced and dynamic environment.

Responsibilities:

• Work is computer based and may include receiving phone calls from prior authorization pharmacy technicians and/or providers where clinical information is involved.
• Role may include consulting physicians/providers with questions and interpretations of clinical guideline criteria and coverage determinations that have been rendered. 
• Role may include participating in quality improvement and process enhancement projects as assigned by management. 
• Role may include consulting with PA technicians and/or physicians regarding use of medications and advise of appropriate formulary alternatives when requested. 
• Dedication to build rapport with coworkers, internal customers, and other departments by demonstrating a strong customer service orientation and a continuous positive image of OptumRx.

• Demonstrate ability to maintain productive working relationships with team members, other internal and external customers, and management team.

• Perform other duties as required.

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  Active State in which pharmacist is employed license is required. 


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  1-3 years practicing pharmacist experience is preferred. 


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  Strong drug product and clinical pharmacy knowledge is required. 
  1-3 years pharmacist experience working in a clinical pharmacy practice setting is preferred. 


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  Pharm.D. degree and completion of Pharmacy Residency is preferred. 


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  Experience developing or operationalizing medication clinical guidelines and/or formulary development is preferred. 


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  Experience working with a PBM company or managed healthcare system is preferred. 


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  Computer and typing proficiency is required, including MS Office applications (Word, Excel, PowerPoint and Outlook). 


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  Excellent written and oral communication skills are required. 


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  Excellent interpersonal and problem-solving skills are required. 


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  Strong customer service orientation and commitment to professionalism is required.


• Demonstrated ability to work independently with minimal supervision
  
   

UnitedHealth Group is working to create the health care system of tomorrow.

Already Fortune 25, we are totally focused on innovation and change. We work a little harder. We aim a little higher. We expect more from ourselves and each other. And at the end of the day, we're doing a lot of good.

Through our family of businesses and a lot of inspired individuals, we're building a high-performance health care system that works better for more people in more ways than ever. Now we're looking to reinforce our team with people who are decisive, brilliant - and built for speed.

Come to UnitedHealth Group, and share your ideas and your passion for doing more. We have roles that will fit your skills and knowledge. We have diverse opportunities that will fit your dreams.

Diversity creates a healthier atmosphere: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, protected veteran status, or disability status.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.