[Hiring] Clinical Pharmacist Prior Authorizations @UnitedHealth Group

Role Description

The Clinical Pharmacist will report to the Director of Pharmacy Services and is primarily responsible for performing prior authorization review for Health Plan of Nevada/Sierra Health and Life Commercial and Health Plan of Nevada Medicaid members. Broad-based and comprehensive knowledge in addition to solid clinical decision making are both critical to success in the role.

This is Monday - Friday 8am to 5pm with rotating holiday and occasional light weekend coverage. You’ll enjoy the flexibility to work remotely from anywhere within the Las Vegas area as you take on some tough challenges.

Primary Responsibilities:

• Perform computer-based work, including receiving phone calls from prior authorization pharmacy technicians and/or providers for clinical information.
• Consult physicians/providers with questions, interpret clinical guideline criteria, and render/review coverage determination for prior authorization cases.
• Consult with pharmacy technicians and/or physicians regarding use of medications and advise of appropriate formulary alternatives when requested.
• Gather complex clinical information, coverage policy and criteria information and work within regulatory guidelines to make coverage determinations.
• Organize workload, set priorities, complete assignments in a timely manner and utilize resources appropriately while complying with department program standards.
• Perform all duties and functions in compliance with state and federal pharmacy laws and regulations.
• Conform with and support department quality assurance and improvement guidelines.
• Dedication to build rapport with coworkers, internal customers, and other departments by demonstrating a solid customer service orientation and a continuous positive image of Health Plan of Nevada.
• Demonstrate ability to maintain productive working relationships with team members, other internal and external customers, and management team.
• Demonstrated ability to work independently with minimal supervision.

Qualifications

• Bachelor of Science Pharmacy or Doctorate of Pharmacy from an accredited college or university.
• Current and unrestricted Nevada Pharmacist license.
• 2+ years of experience working as a licensed pharmacist.
• Demonstrated proficiency with electronic drug information databases (e.g., Micromedex, Lexicomp, UpToDate, PubMed, NCCN).
• Ability to work on-call weekends and holidays as scheduled.

Requirements

• Board Certified by the Board of Pharmacy Specialties (i.e.: BCPS, BCACP) - Preferred.
• Experience working within an Ambulatory or Acute care Clinical Pharmacy Practice setting - Preferred.
• Experience working within a Managed Care / PBM environment - Preferred.
• All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

Benefits

• Comprehensive benefits package.
• Incentive and recognition programs.
• Equity stock purchase.
• 401k contribution (all benefits are subject to eligibility requirements).
• Salary range: $91,700 - $163,700 annually based on full-time employment.