Remote Utilization Management Jobs in Houston, TX

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. 

Work Schedule: Monday-Friday alternating with Tuesday - Saturday every other week; 8AM-5PM, or 9AM-6PM in the local time zone, with some holidays and overtime as needed

You will enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Evaluate prescriptions and patient histories
• Interpret physicians' prescriptions and clinical documentation, accesses clinical criteria and compendia support
• Consult with customers, patients and/or physicians regarding use of medications, potential drug interactions, and clinical status for appeals requests
• Conduct Quality Assurance and verify the accuracy of all prescriptions to render appeal decision
• Provide explanations and interpretations within area of expertise
• Review formulary and utilization management guidelines to determine if the drug should be a covered benefit for the beneficiary based on their medical history
• Research, evaluate, and make determinations on member and provider appeals of pharmacy coverage decisions
• Gather complex clinical information, consider approved compendia, medical literature, coverage policy, and criteria information and work within regulatory guidelines to render decisions. Decision may require consulting with Plan Medical Directors and the beneficiaries treating physicians
• Answer questions from support personnel regarding prescription drugs
• Position requires excellent record keeping skills, thorough documentation, clear and concise written/verbal communications skills

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• Master's degree in PharmD
• Active and unrestricted Pharmacist license in your state of residence
• 1 years of experience as a licensed Pharmacist
• 1 years of experience using online clinical references and accessing professional (clinical and regulatory) internet sites
• 1 years of experience working with onscreen document images
• 1 years of professional experience with business writing and communication
• 1 years of experience of prior authorization case review & rendering PA decisions
• Intermediate level of computer proficiency with MS Office and the ability to navigate a Windows based environment
• Proven ability to adhere to a work schedule of Monday-Friday alternating with Tuesday - Saturday every other week; 8AM-5PM, or 9AM-6PM in local time zone, with some holidays and overtime as needed

Preferred Qualifications:

• Pharmacy Residency experience
• PBM experience
• Experience in Medicaid, Commercial (private), and/or Medicare Part D prescription drug plans, programs, or formularies
• Experience in Coverage Determinations (prior authorization) or member appeals
• Pharmacy reimbursement (third party insurance, Medicare Part D formulary management, Medicaid

*All Telecommuters 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 hourly pay for this role will range from $44 - $79 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. 

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.

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.

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