Opportunities at WellMed , part of the Optum family of businesses. We believe all patients are entitled to the highest level of medical care. Here, you will join a team who shares your passion for helping people achieve better health. With opportunities for physicians, clinical staff and non-patient-facing roles, you can make a difference with us as you discover the meaning behind *Caring. Connecting. Growing together.  *

　　Under general supervision of the SDR Director of Clinical Pharmacy, the SDR Clinical Pharmacist is responsible for completing prior authorization functions as needed for WellMed Managed Care Patients. The Clinical Pharmacist will also work with SDR nurses, Care Team Associates (CTAs) and the Enterprise Care& Value Pharmacy & Therapeutics Committee. This pharmacist will primarily be conducting prior authorization reviews on Part B specialty medications and Oncology medications; assist with criteria development and preferably, should have a working knowledge of Medicare rules and regulations.

　　Primary Responsibilities:

　　Completes assigned daily cases to meet production and performance metrics as determined by the department in order to comply with CMS Part B turnaround times (TAT)

　　Provide timely review for WellMed members by processing prior authorization and medical necessity requests for specialty CMS part B medications

　　Review specialty medication prior authorization requests (i.e. biopharmaceuticals) according to established treatment protocols, clinical criteria and member benefits and make determinations within the defined turnaround times to meet regulatory requirements

　　Knowledgeable of current and emerging clinical trends

　　Active participation in various clinical departmental meetings and forums to improve clinical programs, enhance processes, and share clinical information

　　Continuously look for ways to streamline and improve workflow

　　Assist with user acceptance testing for new clinical programs and system enhancements

　　Ensure and evaluate quality controls and implement opportunities for performance improvement in pharmacy practice specific to specialty pharmacy

　　Serves as a clinical resource and consultant in all areas of pharmacy and medication management for members, patients, providers, internal departments, and/or external third parties

　　Research drug information to maintain drug knowledge and disease state understanding for application to prior authorization reviews

　　Supports overall Enterprise Care &Value department initiatives

　　Follow all policies and procedures related to job

　　Performs all other related duties as assigned to meet departmental objectives

　　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:

　　Doctor of Pharmacy degree

　　Current Pharmacist license to practice in the applicable state

　　2+ years of experience as a Prior Authorization Pharmacist or Clinical Pharmacist, conducting such activities as medication therapy management, clinical rounds, disease state management, etc. Relevant experience includes ANY of the following or a combination thereof:

　　Retail pharmacy

　　Pharmacy Benefit Management

　　Infusion or hospital pharmacy experience

　　Proven excellent written and verbal communication skills

　　Proven excellent relationship building skills

　　Proven solid analytical and PC operation skills

　　Ability to travel as necessary (local, 25%)

　　Preferred Qualifications:

　　Board certification by the Board of Pharmacy Specialties (BPS)

　　Certified Geriatric Pharmacist

　　Certification in Medication Therapy Management (MTM)

　　Ability to obtain additional pharmacist licensure based on business needs

　　Experience with Medicare guidelines

　　Experience working in a metric-driven environment

　　Proven planning and organizational skills to demonstrate leadership and initiative

　　Physical & Mental Requirements :

　　Ability to lift up to pounds

　　Ability to push or pull heavy objects using up to pounds of force

　　Ability to stand for extended periods of time

　　Ability to use fine motor skills to operate office equipment and/or machinery

　　Ability to properly drive and operate a company vehicle

　　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.

　　Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

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