Prior Authorization Pharmacist - Philadelphia, PA

Responsible for supporting the PA program as well all other clinical services through the Clinical Call Center. This role will provide daily operational support to the Prior Authorization (PA) department and Clinical call Center and will serve as clinical resources for internal staff in regards to the Prior authorization program and other clinical call center activities.
 
Primary Responsibilities:

Serve as a clinical resource to the PA staff in reviewing denied, unclear or questionable PA requests
Communicate PA/appeal requirements to healthcare providers as requested
Review and administer PA appeal services including first level appeal reviews and coordination of 2nd level appeals with the appeal vendor
Handle any escalated calls and other issues that may arise in the clinical call center to help maintain a smooth workflow and ensure turnaround times/SLAs are met for each client
Support Clinical Mail order calls, including handling escalated calls from members
Other activities as determined by the PA Clinical Supervisor and management staff

Required Qualifications:

Registered pharmacist with current, active and unrestricted pharmacist license required in the state of practice
1+ years of clinical experience
Strong drug product and clinical pharmacy knowledge
Familiar with clinical program components, formulary designs, prescription benefit trends, and PA programs
Ability to work flexible hours in a fast-paced call center environment including working evenings and weekend hours
Demonstrated ability to work independently with minimal supervision, however when required able to work well in a team setting
Strong computer skills, including MS Window, Word, Outlook and Excel
Excellent interpersonal and problem-solving skills
Strong customer service orientation and commitment to professionalism
Excellent verbal and written communications skills
Excellent organizational and time management skills
Preferred Qualifications:

2+ years of direct clinical program and/or prior authorization experience
Experience with RxClaim or RxAUTH
Prior Authorization and/or call center experience
Knowledge of Medispan/FirstDataBank GPI/GCN designations
Careers with OptumRx. We're one of the largest and most innovative pharmacy benefits managers in the US, serving more than 12 million people nationwide. Here you'll fill far more than prescriptions. As a member of one of our pharmacy teams, you're empowered to be your best and do whatever it takes to help each customer. You'll find unrivaled support and training as well as a wealth of growth and development opportunities driven by your performance and limited only by your imagination. Join us. There's no better place to help people live healthier lives while doing your life's best work.(sm)
 
 
Diversity creates a healthier atmosphere: 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.
 
 
Job Keywords: prior authorization, pharmacist, RxClaim, RxAUTH, Medispan, GPI/GCN, Philadelphia, PA, Pennsylvania