Prior Authorization Pharmacist I - Philadelphia, PA - Full-time / Part-time

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing your life's best work.(sm)
 The Prior Authorization Pharmacist Team is responsible for reviewing Prior Authorization (PA) requests according to applicable clinical criteria, as defined by line of business, client requirements, and applicable regulatory and compliance requirements.  Lines of business include, but are not limited to:  Commercial, and Medicare.
 
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.
 
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and / or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
 
Primary Responsibilities:


Review initial PA requests according to published policies and procedures, applicable clinical criteria, and regulatory and compliance requirements

Provide phone coverage in accordance with call center policies and procedures

Process PA peer to peer reviews and manual requests as scheduled

Assist in the management of daily PA operations, including real time PA inventory and queue management, to ensure all applicable turnaround times (TAT) are met or exceeded

Required Qualifications:

Bachelor’s Degree in Pharmacy
Current unrestricted Registered Pharmacist license in state of Pennsylvania

Minimum 1 year of previous, progressive, related clinical Pharmacist experience

Intermediate-level computer skills in MS Office products and discipline related software (as appropriate)
Preferred Qualifications:


PharmD degree

PBM experience

Prior Authorization experience

Experience working in a clinical pharmacy practice setting
Required Competencies:


Strong customer service orientation and commitment to professionalism

Strong drug product and clinical pharmacy knowledge 

Ability to perform a variety of complex functions

Takes a comprehensive approach to identifying problems, understanding implications, and creating solutions that support overall project progress and success

Demonstrated ability to work independently with minimal supervision 
UnitedHealth Group is working to create the health care system of tomorrow. Already Fortune 14, 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: 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.
 
Job Keywords: Pharmacist, Prior Authorization, Philadelphia, PA, Pennsylvania
 
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