Pharmacist PA/Appeals

Pharmacist PA/Appeals - Remote 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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. As a Prior Authorization Pharmacist , you will support clinical review, decisioning, and communication related to pharmacy prior authorization and appeals requests. This role requires strong clinical judgment, attention to detail, and the ability to apply benefit plan criteria, regulatory requirements, and established workflows to help ensure timely, accurate, and compliant determinations. You will collaborate with providers, members, internal teams, and leadership to resolve inquiries, support quality outcomes, and contribute to a service-focused pharmacy operations environment. You will enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Review, decision, and process prior authorization and appeals requests using established clinical criteria, benefit plan requirements, regulatory guidelines, and applicable client-specific instructions Navigate multiple computer systems, job aids, knowledge resources, and case-management tools to research medication information, verify benefit details, document actions, and support accurate case resolution Receive inbound calls from members, providers, pharmacies, or internal partners to clarify prior authorization requirements, request additional information, explain case status, or provide follow-up within role scope Apply clinical and benefit criteria to support approval, denial, recommendation, or escalation decisions, while clearly documenting the rationale and maintaining compliance with turnaround time, quality, and regulatory expectations Maintain a safe, secure, and compliant work environment by protecting systems, equipment, confidential information, and protected health information, and by promptly reporting any concerns to leadership Demonstrate strong attention to detail when reviewing clinical information, prescription details, diagnosis information, benefit criteria, and supporting documentation to ensure accurate and compliant case processing Accurately document call details, clinical findings, case actions, approvals, denials, transfers, escalations, outreach attempts, and follow-up activity in the appropriate systems Protect confidential information and handle protected health information in accordance with privacy, security, HIPAA, regulatory, and company requirements Use sound judgment to identify incomplete information, clinical uncertainty, workflow barriers, urgent concerns, or situations that require additional pharmacist review, leadership guidance, or escalation Adapt to changing workflows, client requirements, system updates, job aids, and business priorities while maintaining accuracy and service standards Perform other duties as assigned by management Patient Safety & Quality Initiatives: Patient Safety and Quality of work is paramount and it's important for employees to have a safe and secure workspace and communicate with their leadership when that safety (equipment, system, information) is compromised Promote a culture of safety that is equitable, transparent, and engaging for patients, family caregivers, and healthcare workforce Enhance workforce safety and well-being What are the reasons to consider working for UnitedHealth Group? Put it all together - competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates