Job Description

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.

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\xe2\x80\x99ll enjoy the flexibility to work remotely * 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\xe2\x80\x99ll 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\xe2\x80\x99s degree in Pharmacy, Pharm D or higher
• Active, unrestricted Pharmacist license
• 1+ years of experience working as clinical pharmacist in area of coverage determination / appeals and working or utilizing formularies, pharmacy benefits and UM criteria
• PBM experience
• Working knowledge of Medicare Part D, CMS regulations, NCQA, and State regulations
• Proficiency with Microsoft Word, Excel, PowerPoint, Outlook, and Share Point

Preferred Qualifications:

• 2+ years of direct experience with Authorization
• Experience working as a lead or supervisor, or equivalent experience within a team of pharmacists, including managing operations of a work unit

California, Colorado, Connecticut, Nevada, New Jersey, New York, Rhode Island, or Washington Residents Only: The salary range for California, Colorado, Connecticut, Nevada, New Jersey, New York, Rhode Island, or Washington residents is $101,200 to $184,000. 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\xe2\x80\x99ll find a far-reaching choice of benefits and incentives.

*All employees working remotely will be required to adhere to UnitedHealth Group\xe2\x80\x99s 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.

UnitedHealth Group