Clinical Pharmacist Prior Authorizations – Remote within Las Vegas, NV

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 optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together 

The Clinical Pharmacist will report to the Director of Pharmacy Services and is primarily responsible for performing prior authorization review for Health Plan of Nevada/Sierra Health and Life Commercial and Health Plan of Nevada Medicaid members.  Broad-based and comprehensive knowledge in addition to solid clinical decision making are both critical to success in the role.

This is Monday - Friday 8am to 5pm with rotating holiday and occasional light weekend coverage.

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

Primary Responsibilities: 

• Perform computer-based work, including receiving phone calls from prior authorization pharmacy technicians and/or providers for clinical information 
• Consult physicians/providers with questions, interpret clinical guideline criteria, and render/review coverage determination for prior authorization cases
• Consult with pharmacy technicians and/or physicians regarding use of medications and advise of appropriate formulary alternatives when requested
• Gather complex clinical information, coverage policy and criteria information and work within regulatory guidelines to make coverage determinations
• Organize workload, set priorities, complete assignments in a timely manner and utilize resources appropriately while complying with department program standards
• Perform all duties and functions in compliance with state and federal pharmacy laws and regulations
• Conform with and support department quality assurance and improvement guidelines
• Dedication to build rapport with coworkers, internal customers, and other departments by demonstrating a solid customer service orientation and a continuous positive image of Health Plan of Nevada
• Demonstrate ability to maintain productive working relationships with team members, other internal and external customers, and management team
• Demonstrated ability to work independently with minimal supervision

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: 

• Bachelor of Science Pharmacy or Doctorate of Pharmacy from an accredited college or university
• Current and unrestricted Nevada Pharmacist license
• 2+ years of experience working as a licensed pharmacist
• Demonstrated proficiency with electronic drug information databases (e.g., Micromedex, Lexicomp, UpToDate, PubMed, NCCN)
• Ability to work on-call weekends and holidays as scheduled

Preferred Qualifications:  

• Board Certified by the Board of Pharmacy Specialties (i.e.: BCPS, BCACP)
• Experience working within an Ambulatory or Acute care Clinical Pharmacy Practice setting
• Experience working within a Managed Care / PBM environment

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

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you’ll find a far-reaching choice of benefits and incentives. The salary for this role will range from $91,700 - $163,700 annually based on full-time employment. We comply with all minimum wage laws as applicable.

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.    

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.      

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.