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

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 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 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. You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges. Pay is based on several factors including local labor markets, education, work experience, certifications, and more. In addition to your salary, we offer a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401(k) contributions (all benefits subject to eligibility requirements). The hourly pay for this role will range from $44.09 to $78.70 per hour based on full‑time employment. We comply with all minimum wage laws as applicable. 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, 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. #J-18808-Ljbffr