Primary Responsibilities:

Completes assigned daily cases by processing prior authorization and medical necessity requests for specialty CMS part B medications and meet production, performance metrics as determined by the department in order to comply with CMS Part B turnaround times (TAT)

Review specialty medication prior authorization requests (i.e. biopharmaceuticals) according to established treatment protocols, clinical criteria and member benefits and make determinations within the defined turnaround times to meet regulatory requirements

Conduct comprehensive medication reviews for select patient population and collaborate with prescribers and other members of the care team to resolve identified medication-related problems

Assist with oversight of medication management activities in employed clinics across the enterprise, in collaboration with the market nurse leadership, to meet state and federal regulations

Provide clinical recommendations, in alignment with evidence based guidelines, pertaining to, but not limited to, gaps in care, high risk medications, compliance and adherence, drug interactions, therapeutic substitution, and generic substitution to both patients and/or providers

Actively maintain knowledge of current and emerging clinical trends to assist with the development of Clinical Practice Guidelines

Active participation in various clinical departmental meetings and forums to improve clinical programs, enhance processes, and share clinical information

Research new prescription drugs or new applications of existing drugs, develops drug use guidelines and communicate findings to providers

Utilizes available prescription/medical data, health

plan’s formulary and clinical judgement to perform comprehensive medication reviews, retrospective Drug Utilization Review (DUR) to optimize ongoing medication treatments plans for patients/providers and reducing overall cost burden to the health system

Assist with user acceptance testing for new clinical programs and system enhancements

Ensure and evaluate quality controls and implement opportunities for performance improvement in pharmacy practice specific to specialty pharmacy

Serves as a clinical resource and consultant in all areas of pharmacy and medication management for members, patients, providers, internal departments, and/or external third parties.

Supports overall Enterprise Care &Value department initiatives

Follow all policies and procedures related to job

Performs all other related duties as assigned to meet departmental objectives

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:

Doctor of Pharmacy degree

Current Pharmacist license to practice in the applicable state

2 years of experience as a Prior Authorization Pharmacist or Clinical Pharmacist, conducting such activities as medication therapy management, clinical rounds, disease state management, etc. Relevant experience includes ANY of the following or a combination thereof:

Retail pharmacy

Pharmacy Benefit Management

Infusion or hospital pharmacy experience

Proven solid analytical and PC operation skills

Willing or ability to travel as necessary (local, 25%)

Preferred Qualifications:

Board certification by the Board of Pharmacy Specialties (BPS)

Certified Geriatric Pharmacist

Certification in Medication Therapy Management (MTM)

Experience with Medicare guidelines

Experience working in a metric-driven environment

Proven ability to obtain additional pharmacist licensure based on business needs

Proven planning and organizational skills to demonstrate leadership and initiative

Proven excellent written and verbal communication skills

Proven excellent relationship building skills

Physical & Mental Requirements:

Ability to lift up to pounds

Ability to push or pull heavy objects using pounds of force

Ability to stand for extended periods of time

Ability to use fine motor skills to operate office equipment and/or machinery

Ability to properly drive and operate a company vehicle

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.