Appeals Pharmacist - Remote

At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us and start doing your life's best work.(sm)

Work Schedule : 10A-7P CST, some holidays and Saturday rotation coverage

You’ll enjoy the flexibility to work remotely* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Review formulary and utilization management guidelines to determine if the drug should be a covered benefit for the beneficiary based on their medical history
• Provide explanations and interpretations within area of expertise
• Consult with customers, patients and/or physicians regarding use of medications, potential drug interactions, and clinical status for appeals requests
• Gather complex clinical information, consider approved compendia, medical literature, coverage policy, and criteria information and work within regulatory guidelines to render decisions. Decision may require consulting with Plan Medical Directors and the beneficiaries treating physician
• Interpret physicians' prescriptions and clinical documentation, accesses clinical criteria and compendia support
• Evaluate prescriptions and patient histories
• Conduct Quality Assurance and verify the accuracy of all prescriptions to render appeal decision
• Position requires excellent record keeping skills, thorough documentation, clear and concise written/verbal communications skills
• Answer questions from support personnel regarding prescription drugs
• Research, evaluate, and make determinations on member and provider appeals of pharmacy coverage decisions

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:

• Intermediate computer proficiency with MS Office and must have the ability to navigate a Windows based environment
• Experience working with onscreen document images
• Experience using online clinical references and accessing professional (clinical and regulatory) internet sites
• Adhere to a work schedule of 10A-7P CST, with some holidays and Saturday rotation coverage
• Proven excellent written and verbal communication skills
• Active, unrestricted Pharmacist license in your state of residence

Preferred Qualifications:

• Experience in Medicaid, Commercial (private), and/or Medicare Part D prescription drug plans, programs or formularies
• Pharmacy Residency experience
• Pharm D
• Pharmacy reimbursement (third party insurance, Medicare Part D formulary management, Medicaid)
• Experience in Coverage Determinations (prior authorization) or member appeals
• PBM experience

Careers with UnitedHealthcare. Work with a Fortune 5 organization that’s serving millions of people as we transform health care with bold ideas. Bring your energy for driving change for the better. Help us improve health access and outcomes for everyone, as we work to advance health equity, connecting people with the care they need to feel their best. As an industry leader, our commitment to improving lives is second to none.

California, Colorado, Connecticut, Nevada, New York, Rhode Island, or Washington Residents Only: The hourly range for California, Colorado, Connecticut, Nevada, New York, Rhode Island or Washington residents is $40.87 to $80.43. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

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.


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.