Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)
The Clinical Pharmacist Supervisor, Prior Authorization / Appeals
will manage a team of clinical pharmacists to achieve overall performance objectives to the satisfaction of clients, regulatory bodies, and the organization standards.
You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities:
- Exercise judgment and initiative to resolve problems and recommend solutions to complex Prior Authorization Appeal related issues that arise from day to day activity or audit related activities
- Lead in developing and implementing strategies to improve operational efficiencies, trend review analysis, quality improvement projects, procedures, policies, and processes that will contribute to more successful operational business results
- Stay abreast of all new regulatory and reporting requirement updates that impact the operation
- Ensure adherence to related utilization review / prior authorization process requirements
- Respond to escalated prior authorization and appeal calls and/or issues
- Assist Client Services with questions related to prior authorization appeals
- Perform other duties and responsibilities as assigned
- Lead a team of 20+ agents
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's Degree in Pharmacy, Pharm D or higher
- Active, unrestricted Pharmacist license
- PBM experience
- 1+ years of experience working as clinical pharmacist in area of coverage determination / appeals and working or utilizing formularies, pharmacy benefits and UM criteria
- Working knowledge of Medicare Part D, CMS regulations, NCQA, and State regulations
- Proficiency with Microsoft Word, Excel, PowerPoint, Outlook, and Share Point
Careers with OptumRx.
- 2+ years of direct experience with Prior Authorization
- Experience working as a lead or supervisor, or equivalent experience within a team of pharmacists, including managing operations of a work unit
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)
Colorado Residents Only: The salary range for Colorado residents is $94,500 to $171,700. 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 Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.
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: Pharmacist, Supervisor, PA, Prior Authorization, Appeals, PBM, Medicare Part D, CMS, NCQA, State, Regulations, Clinical, Coverage, Benefits, UM, Health Care, Healthcare, Telecommute, Telecommuter, Telecommuting, Work from home, Work at home, Remote, Cypress, CA, Dallas, TX, Jacksonville, FL