Clinical Pharmacist

4 weeks ago


El Segundo, California, United States UnitedHealth Group Full time
Clinical Pharmacist - Pharmacy Utilization Management

**Role Summary:**

We are seeking a skilled Clinical Pharmacist to join our Pharmacy Utilization Management team. As a Clinical Pharmacist, you will play a critical role in ensuring that patients receive the best possible care by reviewing and authorizing prior authorization requests.

**Key Responsibilities:**

* Collaborate with coordinators and nurses to process referrals, including answering clinical questions and collecting appropriate clinical/medical data needed to perform clinical assessments and reviews as per the health plan/employer-agreed criteria within the designated service level agreements

* Evaluate and review all prior authorization requests and render coverage determinations based on clinical criteria and plan design. Includes verifying insurance coverage and eligibility, interpreting clinical guideline criteria, consulting physicians and other healthcare providers, and appropriately utilizing clinical knowledge and resources while complying with department protocols

* Perform and handle inbound and outbound phone calls with coordinators, nurse, physicians, healthcare providers, and/or patients to facilitate prior authorization requests, answer inquiries, and/or resolve escalations

**Requirements:**

* Pharm D

* 2+ years of experience working as a Prior Authorization pharmacist

* Experience using clinical resources, e.g., Micromedex, Lexicomp, Clinical Pharmacology, Up to Date

* Proven ability to prioritize, quickly assess, manage multiple tasks and adapt to constantly changing situations

* Proven excellent organizational skills. Solid detail orientation

* Must be located in California

**What We Offer:**

* Competitive salary range: $88,000 to $173,200 annually

* Comprehensive benefits package

* Incentive and recognition programs

* Equity stock purchase

* 401k contribution

**UnitedHealth Group Mission:**

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.

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