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- Work is computer based and include 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, sets priorities, completes assignments in a timely manner and utilizes 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 supports department quality assurance and improvement guidelines
- Dedication to build rapport with coworkers, internal customers, and other departments by demonstrating a strong customer service orientation and a continuous positive image of OptumRx.
- Demonstrate ability to maintain productive working relationships with team members, other internal and external customers, and management team.
- Bachelor's Degree Pharm D or higher
- Experience in Coverage Determinations (prior authorization) or member appeals
- 1+ years practicing pharmacist experience
- PBM Experience
- Pharmacy Residency experience
- Experience in Commercial (private), and/or Medicare Part D prescription drug plans, programs or formularies
If you're ready to talk about groundbreaking interactions, let's talk about what happens when a firm that touches millions of lives decides to gather results from millions of prescriptions every month and analyze their impact. Let's talk about smart, motivated teams. Let's talk about more effective and affordable healthcare solutions. This is caring. This is great chemistry. This is the way to make a difference. We're doing all this, and more, through a greater dedication to our shared values of integrity, compassion, relationships, innovation and performance. Join us and start doing your life’s best work.
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.
Keywords: pharmacist, optum, Arizona, PBM, Medicare