Opportunity is here


Lead Pharmacist PA Appeals - Virtual - 2220250



Sugar Land, TX, USA · Chicago, IL, USA · Boston, MA, USA · Phoenix, AZ, USA · Los Angeles, CA, USA · Tampa, FL, USA
Posted on Wednesday, May 29, 2024

At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.

You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

  • Support primary team manager and director with all tasks related to appeal review
  • Serve as a subject-matter-expert (SME) for benefit management and appeal cases review including job aids, processes, policies, regulations and clinical case review questions
  • Assist with recruitment, onboarding, post-training mentor for new hires and contract staff
  • Lead meetings, presentations, and communications as needed for huddles, medical direction questions/forums, team meetings, refreshers, Prior Auth, Benefit Ops and monthly mock audits, staff IRR review and feedback
  • Serves as lead for all team projects and provides oversight and direction for special projects, macro updates, system updates and troubleshooting
  • Case review work with modified production requirements
  • Fulfills other duties as assigned by management

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:

  • Active and unrestricted Pharmacist license
  • 2+ years of experience working as A&G Pharmacist
  • Proven ability to meet job performance expectations with no open Corrective Action Plan
  • Demonstrated subject matter expertise in pharmacy appeal work
  • Demonstrated ability to build positive rapport with peers, leadership and business partners
  • Proven effective communication and presentation skills

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, or Washington Residents Only: The hourly range for this role is $42.31 to $83.27 per hour. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. 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.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

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.