Is the Pharmacist PA/Appeals position at UnitedHealth Group fully remote?

Yes, this Pharmacist PA/Appeals position at UnitedHealth Group is a remote position. The role is available for candidates in United States.

Is this a full-time or part-time Pharmacist PA/Appeals role?

This is a full-time Pharmacist PA/Appeals position at UnitedHealth Group.

What benefits does UnitedHealth Group offer for this position?

UnitedHealth Group offers the following benefits: Paid Time Off, Dental Insurance, Vision Insurance, Life Insurance, Employee Discounts, Employee Assistance Program.

What is the salary range for the Pharmacist PA/Appeals position?

The salary range for this Pharmacist PA/Appeals role is $0.044k - $0.079k.

How do I apply for the Pharmacist PA/Appeals position at UnitedHealth Group?

You can apply for this Pharmacist PA/Appeals position by clicking the "Apply Now" button on this page, which will take you to UnitedHealth Group's application portal.

Pharmacist PA/Appeals at UnitedHealth Group

United States

$0.044k - $0.079k

Pharmacist PA/Appeals - RemoteOptum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.As a Prior Authorization Pharmacist, you will support clinical review, decisioning, and communication related to pharmacy prior authorization and appeals requests. This role requires strong clinical judgment, attention to detail, and the ability to apply benefit plan criteria, regulatory requirements, and established workflows to help ensure timely, accurate, and compliant determinations. You will collaborate with providers, members, internal teams, and leadership to resolve inquiries, support quality outcomes, and contribute to a service-focused pharmacy operations environment.You will enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.Primary Responsibilities: <ul style="margin-top:0in;" type="disc"><li class="MsoNormal" style="mso-list:l2 level1 lfo1;tab-stops:list .5in;">Review, decision, and process prior authorization and appeals requests using established clinical criteria, benefit plan requirements, regulatory guidelines, and applicable client-specific instructions</li><li class="MsoNormal" style="mso-list:l2 level1 lfo1;tab-stops:list .5in;">Navigate multiple computer systems, job aids, knowledge resources, and case-management tools to research medication information, verify benefit details, document actions, and support accurate case resolution</li><li class="MsoNormal" style="mso-list:l2 level1 lfo1;tab-stops:list .5in;">Receive inbound calls from members, providers, pharmacies, or internal partners to clarify prior authorization requirements, request additional information, explain case status, or provide follow-up within role scope</li><li class="MsoNormal" style="mso-list:l2 level1 lfo1;tab-stops:list .5in;">Apply clinical and benefit criteria to support approval, denial, recommendation, or escalation decisions, while clearly documenting the rationale and maintaining compliance with turnaround time, quality, and regulatory expectations</li><li class="MsoNormal" style="mso-list:l2 level1 lfo1;tab-stops:list .5in;">Maintain a safe, secure, and compliant work environment by protecting systems, equipment, confidential information, and protected health information, and by promptly reporting any concerns to leadership</li></ul><ul style="margin-top:0in;" type="disc"><li class="MsoNormal" style="mso-list:l0 level1 lfo3;tab-stops:list .5in;">Demonstrate strong attention to detail when reviewing clinical information, prescription details, diagnosis information, benefit criteria, and supporting documentation to ensure accurate and compliant case processing</li><li class="MsoNormal" style="mso-list:l0 level1 lfo3;tab-stops:list .5in;">Accurately document call details, clinical findings, case actions, approvals, denials, transfers, escalations, outreach attempts, and follow-up activity in the appropriate systems</li><li class="MsoNormal" style="mso-list:l0 level1 lfo3;tab-stops:list .5in;">Protect confidential information and handle protected health information in accordance with privacy, security, HIPAA, regulatory, and company requirements</li><li class="MsoNormal" style="mso-list:l0 level1 lfo3;tab-stops:list .5in;">Use sound judgment to identify incomplete information, clinical uncertainty, workflow barriers, urgent concerns, or situations that require additional pharmacist review, leadership guidance, or escalation</li><li class="MsoNormal" style="mso-list:l0 level1 lfo3;tab-stops:list .5in;">Adapt to changing workflows, client requirements, system updates, job aids, and business priorities while maintaining accuracy and service standards</li><li class="MsoNormal" style="mso-list:l0 level1 lfo3;tab-stops:list .5in;">Perform other duties as assigned by management</li></ul>Patient Safety & Quality Initiatives:<ul style="margin-top:0in;" type="disc"><li class="MsoNormal" style="mso-list:l1 level1 lfo2;">Patient Safety and Quality of work is paramount and it’s important for employees to have a safe and secure workspace and communicate with their leadership when that safety (equipment, system, information) is compromised</li><li class="MsoNormal" style="mso-list:l1 level1 lfo2;">Promote a culture of safety that is equitable, transparent, and engaging for patients, family caregivers, and healthcare workforce</li><li class="MsoNormal" style="mso-list:l1 level1 lfo2;">Enhance workforce safety and well-being</li></ul>What are the reasons to consider working for UnitedHealth Group?  Put it all together – competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:<ul style="margin-top:0in;" type="disc"><li class="MsoNormal" style="mso-list:l3 level1 lfo4;tab-stops:list .5in;">Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays</li><li class="MsoNormal" style="mso-list:l3 level1 lfo4;tab-stops:list .5in;">Medical plan options along with participation in a Health Spending Account or Health Savings Account</li><li class="MsoNormal" style="mso-list:l3 level1 lfo4;tab-stops:list .5in;">Dental, Vision, Life & AD&D Insurance, Short-Term Disability, and Long-Term Disability coverage</li><li class="MsoNormal" style="mso-list:l3 level1 lfo4;tab-stops:list .5in;">401(k) Savings Plan, Employee Stock Purchase Plan</li><li class="MsoNormal" style="mso-list:l3 level1 lfo4;tab-stops:list .5in;">Education Reimbursement</li><li class="MsoNormal" style="mso-list:l3 level1 lfo4;tab-stops:list .5in;">Employee Discounts</li><li class="MsoNormal" style="mso-list:l3 level1 lfo4;tab-stops:list .5in;">Employee Assistance Program</li><li class="MsoNormal" style="mso-list:l3 level1 lfo4;tab-stops:list .5in;">Employee Referral Bonus Program</li><li class="MsoNormal" style="mso-list:l3 level1 lfo4;tab-stops:list .5in;">Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)</li></ul>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:<ul style="margin-top:0in;" type="disc"><li class="MsoNormal" style="mso-list:l1 level1 lfo1;">Bachelor of Pharmacy or Doctor of Pharmacy degree from an accredited pharmacy program and an active pharmacist license</li><li class="MsoNormal" style="mso-list:l1 level1 lfo1;">Current, unrestricted pharmacist license in the state of residence, with responsibility for maintaining licensure in good standing and meeting any applicable continuing education requirements</li><li class="MsoNormal" style="mso-list:l1 level1 lfo1;">Intermediate level of proficiency with Microsoft Excel, Word, Outlook, and Teams, including the ability to create, edit, save, send, organize, and manage basic documents, spreadsheets, emails, meetings, and communications</li><li class="MsoNormal" style="mso-list:l1 level1 lfo1;">Ability to work any assigned shift within the 5:00 AM to 12:00 AM operating window, including flexible hours, overtime, weekends, and holidays as required by business and patient/member needs</li></ul>Preferred Qualifications:<ul style="margin-top:0in;" type="disc"><li class="MsoNormal" style="mso-list:l0 level1 lfo2;">Knowledge of Medicare Part D, commercial, Medicaid, exchange, or client-specific pharmacy benefit requirements</li><li class="MsoNormal" style="mso-list:l0 level1 lfo2;">Knowledge of call center systems such as CMS, IEX, CTI, TCS, or similar telephony, workforce, and case-management platforms</li><li class="MsoNormal" style="mso-list:l0 level1 lfo2;">Experience working in a high-volume, production-based, quality-monitored, or compliance-driven environment</li><li class="MsoNormal" style="mso-list:l0 level1 lfo2;">Familiarity with pharmacy terminology, medication names, brand and generic drug names, SIG codes, benefit terminology, and healthcare documentation standards</li></ul>Soft Skills:<ul style="margin-top:0in;" type="disc"><li class="MsoNormal" style="mso-list:l2 level1 lfo3;tab-stops:list .5in;">Strong verbal and written communication skills, with the ability to explain clinical, benefit, and case-related information clearly, professionally, and accurately to providers, members, pharmacists, leaders, and internal partners</li><li class="MsoNormal" style="mso-list:l2 level1 lfo3;tab-stops:list .5in;">Strong attention to detail and ability to consistently apply clinical criteria, workflow instructions, documentation standards, privacy requirements, and quality expectations</li><li class="MsoNormal" style="mso-list:l2 level1 lfo3;tab-stops:list .5in;">Ability to manage competing priorities, maintain productivity, follow through on assigned work, and meet service-level expectations in a fast-paced, metric-driven environment</li><li class="MsoNormal" style="mso-list:l2 level1 lfo3;tab-stops:list .5in;">Ability to work efficiently across multiple systems, screens, job aids, knowledge articles, queues, and electronic workflows while maintaining accuracy during calls, clinical review, and case processing</li><li class="MsoNormal" style="mso-list:l2 level1 lfo3;tab-stops:list .5in;">Critical thinking, problem-solving, and sound professional judgment to identify risks, incomplete information, potential compliance concerns, and cases requiring escalation or additional review</li><li class="MsoNormal" style="mso-list:l2 level1 lfo3;tab-stops:list .5in;">Ability to receive feedback, adapt to coaching, adjust performance, and support continuous improvement in quality, productivity, service, compliance, and member/provider experience outcomes</li></ul>Physical Requirements and Work Environment:<ul style="margin-top:0in;" type="disc"><li class="MsoNormal" style="mso-list:l2 level1 lfo3;tab-stops:list .5in;">Reliable high-speed home internet access, with the ability to use a hard-wired ethernet connection when required</li><li class="MsoNormal" style="mso-list:l2 level1 lfo3;tab-stops:list .5in;">Secure, private home workspace that supports protection of confidential information and compliance with company telecommuter, privacy, and security policies</li><li class="MsoNormal" style="mso-list:l2 level1 lfo3;tab-stops:list .5in;">Intermediate comfort using a computer, including keyboard and mouse navigation, opening applications, switching between multiple systems and screens, and learning new tools or workflows</li></ul><p class="MsoNormal" style="-webkit-text-stroke-width:0px;background-color:rgb(255, 255, 255);color:rgb(0, 0, 0);font-family:"Open Sans", "Segoe UI", Frutiger, "Frutiger Linotype", "Dejavu Sans", "Helvetica Neue", Arial, sans-serif;font-size:13.02px;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:400;letter-spacing:normal;line-height:normal;margin:0px 0px 12px;orphans:2;text-align:start;text-decoration-color:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-transform:none;white-space:normal;widows:2;word-spacing:0px;">*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.<p class="MsoNormal" style="-webkit-text-stroke-width:0px;background-color:rgb(255, 255, 255);color:rgb(0, 0, 0);font-family:"Open Sans", "Segoe UI", Frutiger, "Frutiger Linotype", "Dejavu Sans", "Helvetica Neue", Arial, sans-serif;font-size:13.02px;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:400;letter-spacing:normal;margin:0px 0px 12px;orphans:2;text-align:start;text-decoration-color:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-transform:none;white-space:normal;widows:2;word-spacing:0px;">   <p style="-webkit-text-stroke-width:0px;background-color:rgb(255, 255, 255);color:rgb(0, 0, 0);font-family:Tahoma;font-size:13.02px;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:400;letter-spacing:normal;margin:0px 0px 12px;orphans:2;text-align:start;text-decoration-color:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-transform:none;white-space:normal;widows:2;word-spacing:0px;"><span class="TextRun SCXO114495570 BCX0 NormalTextRun" style="-webkit-tap-highlight-color:transparent;-webkit-text-stroke-width:0px;-webkit-user-drag:none;font-style:normal;font-variant-caps:normal;font-variant-ligatures:none !important;font-weight:400;letter-spacing:normal;line-height:20.7px;margin:0px;orphans:2;padding:0px;text-align:left;text-decoration-color:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-transform:none;user-select:text;white-space:normal;widows:2;word-spacing:0px;" data-contrast="auto" xml:lang="EN-US" lang="EN-US">Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you’ll find a far-reaching choice of benefits and incentives. The salary for this role will range from $$44.00 to $79.00 <span style="-webkit-text-stroke-width:0px;display:inline !important;float:none;font-style:normal;font-variant-caps:normal;font-variant-ligatures:none;font-weight:400;letter-spacing:normal;orphans:2;text-align:left;text-decoration-color:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-transform:none;white-space:normal;widows:2;word-spacing:0px;">per hour based on full-time employment<span class="TextRun SCXO114495570 BCX0 NormalTextRun" style="-webkit-tap-highlight-color:transparent;-webkit-text-stroke-width:0px;-webkit-user-drag:none;font-style:normal;font-variant-caps:normal;font-variant-ligatures:none !important;font-weight:400;letter-spacing:normal;line-height:20.7px;margin:0px;orphans:2;padding:0px;text-align:left;text-decoration-color:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-transform:none;user-select:text;white-space:normal;widows:2;word-spacing:0px;" data-contrast="auto" xml:lang="EN-US" lang="EN-US">. We comply with all minimum wage laws as applicable.<span class="EOP SCXO114495570 BCX0" style="-webkit-tap-highlight-color:transparent;-webkit-text-stroke-width:0px;-webkit-user-drag:none;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:400;letter-spacing:normal;line-height:20.7px;margin:0px;orphans:2;padding:0px;text-align:left;text-decoration-color:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-transform:none;user-select:text;white-space:normal;widows:2;word-spacing:0px;"> <p style="-webkit-text-stroke-width:0px;background-color:rgb(255, 255, 255);color:rgb(0, 0, 0);font-family:Tahoma;font-size:13.02px;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:400;letter-spacing:normal;margin:0px 0px 12px;orphans:2;text-align:start;text-decoration-color:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-transform:none;white-space:normal;widows:2;word-spacing:0px;"><span class="EOP SCXO258445584 BCX0" style="-webkit-tap-highlight-color:transparent;-webkit-text-stroke-width:0px;-webkit-user-drag:none;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:400;letter-spacing:normal;line-height:20.7px;margin:0px;orphans:2;padding:0px;text-align:left;text-decoration-color:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-transform:none;user-select:text;white-space:normal;widows:2;word-spacing:0px;">   <span class="EOP SCXO221598260 BCX0" style="-webkit-tap-highlight-color:transparent;-webkit-text-stroke-width:0px;-webkit-user-drag:none;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:400;letter-spacing:normal;line-height:20.7px;margin:0px;orphans:2;padding:0px;text-align:left;text-decoration-color:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-transform:none;user-select:text;white-space:normal;widows:2;word-spacing:0px;"> <p style="-webkit-text-stroke-width:0px;background-color:rgb(255, 255, 255);color:rgb(0, 0, 0);font-family:Tahoma;font-size:13.02px;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:400;letter-spacing:normal;margin:0px 0px 12px;orphans:2;text-align:start;text-decoration-color:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-transform:none;white-space:normal;widows:2;word-spacing:0px;">Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. <p style="-webkit-text-stroke-width:0px;background-color:rgb(255, 255, 255);color:rgb(0, 0, 0);font-family:Tahoma;font-size:13.02px;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:400;letter-spacing:normal;margin:0px 0px 12px;orphans:2;text-align:start;text-decoration-color:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-transform:none;white-space:normal;widows:2;word-spacing:0px;">    <p style="-webkit-text-stroke-width:0px;background-color:rgb(255, 255, 255);color:rgb(0, 0, 0);font-family:Tahoma;font-size:13.02px;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:400;letter-spacing:normal;margin:0px 0px 12px;orphans:2;text-align:start;text-decoration-color:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-transform:none;white-space:normal;widows:2;word-spacing:0px;">Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. <p style="-webkit-text-stroke-width:0px;background-color:rgb(255, 255, 255);color:rgb(0, 0, 0);font-family:Tahoma;font-size:13.02px;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:400;letter-spacing:normal;margin:0px 0px 12px;orphans:2;text-align:start;text-decoration-color:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-transform:none;white-space:normal;widows:2;word-spacing:0px;">     <p style="-webkit-text-stroke-width:0px;background-color:rgb(255, 255, 255);color:rgb(0, 0, 0);font-family:Tahoma;font-size:13.02px;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:400;letter-spacing:normal;margin:0px 0px 12px;orphans:2;text-align:center;text-decoration-color:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-transform:none;white-space:normal;widows:2;word-spacing:0px;">At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location, and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.<p style="-webkit-text-stroke-width:0px;background-color:rgb(255, 255, 255);color:rgb(0, 0, 0);font-family:Tahoma;font-size:13.02px;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:400;letter-spacing:normal;margin:0px 0px 12px;orphans:2;text-align:center;text-decoration-color:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-transform:none;white-space:normal;widows:2;word-spacing:0px;">     <p style="-webkit-text-stroke-width:0px;background-color:rgb(255, 255, 255);color:rgb(0, 0, 0);font-family:Tahoma;font-size:13.02px;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:400;letter-spacing:normal;margin:0px 0px 12px;orphans:2;text-align:center;text-decoration-color:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-transform:none;white-space:normal;widows:2;word-spacing:0px;">     <p style="-webkit-text-stroke-width:0px;background-color:rgb(255, 255, 255);color:rgb(0, 0, 0);font-family:Tahoma;font-size:13.02px;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:400;letter-spacing:normal;margin:0px 0px 12px;orphans:2;text-align:center;text-decoration-color:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-transform:none;white-space:normal;widows:2;word-spacing:0px;">UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.<p style="-webkit-text-stroke-width:0px;background-color:rgb(255, 255, 255);color:rgb(0, 0, 0);font-family:Tahoma;font-size:13.02px;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:400;letter-spacing:normal;margin:0px 0px 12px;orphans:2;text-align:center;text-decoration-color:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-transform:none;white-space:normal;widows:2;word-spacing:0px;">     <p style="-webkit-text-stroke-width:0px;background-color:rgb(255, 255, 255);color:rgb(0, 0, 0);font-family:Tahoma;font-size:13.02px;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:400;letter-spacing:normal;margin:0px 0px 12px;orphans:2;text-align:center;text-decoration-color:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-transform:none;white-space:normal;widows:2;word-spacing:0px;">UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.<p style="-webkit-text-stroke-width:0px;background-color:rgb(255, 255, 255);color:rgb(0, 0, 0);font-family:Tahoma;font-size:13.02px;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:400;letter-spacing:normal;margin:0px 0px 12px;orphans:2;text-align:start;text-decoration-color:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-transform:none;white-space:normal;widows:2;word-spacing:0px;">   <p style="-webkit-text-stroke-width:0px;background-color:rgb(255, 255, 255);color:rgb(0, 0, 0);font-family:Tahoma;font-size:13.02px;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:400;letter-spacing:normal;margin:0px 0px 12px;orphans:2;text-align:start;text-decoration-color:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-transform:none;white-space:normal;widows:2;word-spacing:0px;">    <p style="-webkit-text-stroke-width:0px;background-color:rgb(255, 255, 255);color:rgb(0, 0, 0);font-family:Tahoma;font-size:13.02px;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:400;letter-spacing:normal;margin:0px 0px 12px;orphans:2;text-align:start;text-decoration-color:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-transform:none;white-space:normal;widows:2;word-spacing:0px;">#RPO #GREEN

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Remote Opportunity

Pharmacist PA/Appeals

Join UnitedHealth Group as a mid professional working remotely from United States. Explore the role, benefits, and apply in one place.

Pharmacist PA/Appeals

UnitedHealth Group

Full Time

$0.044k - $0.079k

4 weeks ago

Pharmacist PA/Appeals - Remote Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they…

United States

Engineering

Mid

Clinical Review

Prior Authorization

Appeals processing

+5 more

Job Description

Pharmacist PA/Appeals - Remote

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

As a Prior Authorization Pharmacist, you will support clinical review, decisioning, and communication related to pharmacy prior authorization and appeals requests. This role requires strong clinical judgment, attention to detail, and the ability to apply benefit plan criteria, regulatory requirements, and established workflows to help ensure timely, accurate, and compliant determinations. You will collaborate with providers, members, internal teams, and leadership to resolve inquiries, support quality outcomes, and contribute to a service-focused pharmacy operations environment.

You will enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

Review, decision, and process prior authorization and appeals requests using established clinical criteria, benefit plan requirements, regulatory guidelines, and applicable client-specific instructions
Navigate multiple computer systems, job aids, knowledge resources, and case-management tools to research medication information, verify benefit details, document actions, and support accurate case resolution
Receive inbound calls from members, providers, pharmacies, or internal partners to clarify prior authorization requirements, request additional information, explain case status, or provide follow-up within role scope
Apply clinical and benefit criteria to support approval, denial, recommendation, or escalation decisions, while clearly documenting the rationale and maintaining compliance with turnaround time, quality, and regulatory expectations
Maintain a safe, secure, and compliant work environment by protecting systems, equipment, confidential information, and protected health information, and by promptly reporting any concerns to leadership

Demonstrate strong attention to detail when reviewing clinical information, prescription details, diagnosis information, benefit criteria, and supporting documentation to ensure accurate and compliant case processing
Accurately document call details, clinical findings, case actions, approvals, denials, transfers, escalations, outreach attempts, and follow-up activity in the appropriate systems
Protect confidential information and handle protected health information in accordance with privacy, security, HIPAA, regulatory, and company requirements
Use sound judgment to identify incomplete information, clinical uncertainty, workflow barriers, urgent concerns, or situations that require additional pharmacist review, leadership guidance, or escalation
Adapt to changing workflows, client requirements, system updates, job aids, and business priorities while maintaining accuracy and service standards
Perform other duties as assigned by management

Patient Safety & Quality Initiatives:

Patient Safety and Quality of work is paramount and it’s important for employees to have a safe and secure workspace and communicate with their leadership when that safety (equipment, system, information) is compromised
Promote a culture of safety that is equitable, transparent, and engaging for patients, family caregivers, and healthcare workforce
Enhance workforce safety and well-being

What are the reasons to consider working for UnitedHealth Group? Put it all together – competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:

Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
Medical plan options along with participation in a Health Spending Account or Health Savings Account
Dental, Vision, Life & AD&D Insurance, Short-Term Disability, and Long-Term Disability coverage
401(k) Savings Plan, Employee Stock Purchase Plan
Education Reimbursement
Employee Discounts
Employee Assistance Program
Employee Referral Bonus Program
Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)

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:

Bachelor of Pharmacy or Doctor of Pharmacy degree from an accredited pharmacy program and an active pharmacist license
Current, unrestricted pharmacist license in the state of residence, with responsibility for maintaining licensure in good standing and meeting any applicable continuing education requirements
Intermediate level of proficiency with Microsoft Excel, Word, Outlook, and Teams, including the ability to create, edit, save, send, organize, and manage basic documents, spreadsheets, emails, meetings, and communications
Ability to work any assigned shift within the 5:00 AM to 12:00 AM operating window, including flexible hours, overtime, weekends, and holidays as required by business and patient/member needs

Preferred Qualifications:

Knowledge of Medicare Part D, commercial, Medicaid, exchange, or client-specific pharmacy benefit requirements
Knowledge of call center systems such as CMS, IEX, CTI, TCS, or similar telephony, workforce, and case-management platforms
Experience working in a high-volume, production-based, quality-monitored, or compliance-driven environment
Familiarity with pharmacy terminology, medication names, brand and generic drug names, SIG codes, benefit terminology, and healthcare documentation standards

Soft Skills:

Strong verbal and written communication skills, with the ability to explain clinical, benefit, and case-related information clearly, professionally, and accurately to providers, members, pharmacists, leaders, and internal partners
Strong attention to detail and ability to consistently apply clinical criteria, workflow instructions, documentation standards, privacy requirements, and quality expectations
Ability to manage competing priorities, maintain productivity, follow through on assigned work, and meet service-level expectations in a fast-paced, metric-driven environment
Ability to work efficiently across multiple systems, screens, job aids, knowledge articles, queues, and electronic workflows while maintaining accuracy during calls, clinical review, and case processing
Critical thinking, problem-solving, and sound professional judgment to identify risks, incomplete information, potential compliance concerns, and cases requiring escalation or additional review
Ability to receive feedback, adapt to coaching, adjust performance, and support continuous improvement in quality, productivity, service, compliance, and member/provider experience outcomes

Physical Requirements and Work Environment:

Reliable high-speed home internet access, with the ability to use a hard-wired ethernet connection when required
Secure, private home workspace that supports protection of confidential information and compliance with company telecommuter, privacy, and security policies
Intermediate comfort using a computer, including keyboard and mouse navigation, opening applications, switching between multiple systems and screens, and learning new tools or workflows

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you’ll find a far-reaching choice of benefits and incentives. The salary for this role will range from $$44.00 to $79.00 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location, and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

#RPO #GREEN

Benefits

Paid Time Off
Dental Insurance
Vision Insurance
Life Insurance
Employee Discounts
Employee Assistance Program

Skills

Clinical Review

Prior Authorization

Appeals processing

Pharmacy Operations

Medication Knowledge

Regulatory Compliance

Case management

Clinical Judgment

Ready to Apply?

Join UnitedHealth Group today

Salary Range

$0.044k - $0.079k

Posted 4 weeks ago

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