Clinical Nurse Practitioner or Pharmacist - Prior Authorization or 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 diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together. 

The Clinical Pharmacist or Clinical Nurse Practitioner 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.

Working hours: A 40-hour work week, the shift will be determined by the hiring manager upon hire.

• Shift 1: Monday - Friday 8 hour
• Shift 2: Tues - Saturday 8 hour
• Shift 3: Wed - Saturday 10 hour
• Shift 4: Sunday - Thursday 8 hour
• 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, as well as broader case and disease management programs, to promote optimal clinical outcomes
• Provide clinical expertise in the development, implementation, and continuous improvement of specialty medication utilization management programs
• Serve as a subject matter expert on evidence-based clinical guidelines, ensuring policies, procedures, and decision-making processes reflect current clinical best practices
• Conduct dosage-based clinical reviews to ensure appropriate medication use and adherence to established guidelines
• Perform pre-service reviews for specialty medications to assess medical necessity and appropriateness of care
• Complete documentation audits to ensure compliance with organizational standards and regulatory requirements
• Conduct and support physician-led clinical audits to evaluate quality, consistency, and compliance
• Develop and deliver clinical education and training for internal teams and stakeholders
• Analyze clinical and operational data, including quality metrics, claims data, health records, and utilization trends, to identify opportunities for improving patient outcomes, care delivery, and process efficiency
• Collaborate with cross-functional teams to support quality improvement initiatives and enhance clinical program effectiveness
• Perform additional duties and special projects assigned

What are the reasons to consider working for UnitedHealth Group?   Put it all together - competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:

• Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
• Medical Plan options along with participation in a Health Spending Account or a Health Saving account
• Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage
• 401(k) Savings Plan, Employee Stock Purchase Plan
• Education Reimbursement
• Employee Discounts
• Employee Assistance Program
• Employee Referral Bonus Program
• Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)

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:

• High School Diploma/GED
• Licensed Nurse Practitioner OR Pharm D (License must be in state of residence, current and unrestricted)
• 3+ years of clinical experience
• 3+ years of experience working with evidence-based medicine related to specialty medications
• 2+ years of experience administering and/or advising on specialty medication treatment plans (utilizing/reviewing medical case notes, medication list, lab results)
• 2+ years of hospital experience
• 1 + years of experience handling sensitive issues with members and providers in a confidential manner
• Access to a designated quiet workspace in your home (separated from non-workspace areas) with the ability to secure Protected Health Information (PHI)
• Live in a location where there is a UnitedHealth Group approved high-speed internet connection to leverage existing high-speed internet 

Preferred Qualifications:

• Experience in utilization management
• 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 

Soft Skills:

• Ability to work independently and maintain good judgment and accountability 
• Demonstrated ability to work well with health care providers 
• Strong organizational and time management skills 
• Ability to multi-task and prioritize tasks to meet all deadlines 
• Ability to work well under pressure in a fast-paced environment 
• Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying information in a manner that others can understand, as well as ability to understand and interpret information from others     

*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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