Clinical Nurse Practitioner or Pharmacist (Prior Authorization/Appeals) - Specialty Infusion

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

The Clinical Pharmacist will focus on providing evidence - based and clinical guidance to help implement a next - generation comprehensive specialty solutions which will successfully meet clinical, quality, and financial performance objectives. This solution will help ensure providers deliver high - quality, evidence-based and cost - efficient specialty care for our clients. As such, this newly created role requires an innovative, hands - on, action - oriented clinical expert. The position will serve as a key Specialty medicine expert dedicated to helping ensure high levels of quality, affordability, and member and provider satisfaction.

Schedule:

Monday - Friday 8 hour shift

Tues - Saturday 8 hour shift

Wed - Saturday 10 hour shift

Sunday - Thursday 8 hour shift

Cannot start earlier than 7am CST

Weekend Requirement: 1 Saturday per month, 1 Sunday per quarter

Holiday Requirement: 3 holidays per year

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

Primary Responsibilities: 

• Support utilization review determinations for specialty medication populations, and broader case and disease management teams to achieve optimal clinical outcomes
• Provide clinical guidance in the creation, implementation and refinement of a specialty medication utilization management solution
• Serve as a subject matter expert in evidence - based medical guidelines and help ensure all clinical relevant policies and processes are informed by the best available evidence
• Dosage-based reviews
• Preservice Specialty Medication Reviews
• Post-auto-approval documentation audits
• Initial Onboarding and Ongoing Specialty Medication Training
• Lead MD Clinical Audits
• Clinical education
• Evaluate clinical and other data (e.g., quality metrics, claims & health record data, utilization data) to identify opportunities for improvement of clinical care and processes

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:

• Licensed Nurse Practitioner OR Pharm D (License must be in state of residence, current and unrestricted)
• 3+ years clinical experience
• 2+ years of experience administering and/or advising on specialty medication treatment plans (utilizing/reviewing medical case notes, medication list, lab results)
• Hospital experience
• Experience in utilization management
• Experience working with evidence-based medicine related to specialty medications
• Dedicated workspace from home
• Access to high-speed internet from home (Broadband Cable, DSL or Fiber)

Preferred Qualifications

• 5+ years of experience in hospital 
• 3+ years of utilization management experience
• Additional Licensure in NM, MN, AZ
• Experience working in managed care, medical care delivery systems, utilization management, case management, disease management, quality management, product development and/or peer review
• Demonstrated ability to work cross-functionally to gain credibility, influence and partner with other clinical and non-clinical professionals

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

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.