Remote Pharmacist – Prior Authorization & Appeals

About the role

UnitedHealthcare is seeking a licensed pharmacist to join its nationwide remote team. You will evaluate prescription requests, interpret clinical documentation, and make coverage decisions for appeals while providing clear guidance to patients, providers, and internal staff.

Key responsibilities

• Review prescriptions, patient histories, and physicians' orders using clinical criteria and compendia.
• Consult with customers, patients, and physicians about medication use, drug interactions, and appeal status.
• Conduct quality‑assurance checks and verify prescription accuracy for appeal decisions.
• Apply formulary and utilization‑management guidelines to determine benefit coverage.
• Research medical literature, compendia, and policy criteria to render decisions within regulatory guidelines.
• Collaborate with Plan Medical Directors and treating physicians when complex cases arise.
• Answer internal support queries regarding prescription drugs.
• Maintain thorough documentation and clear written/verbal communication.

Required profile

• Active, unrestricted PharmD license in the state of residence.
• At least 1 year of experience as a licensed pharmacist.
• Experience with online clinical references, professional regulatory sites, and on‑screen document images.
• Professional business writing and communication experience.
• Prior authorization case review and decision‑making experience.
• Ability to work a rotating schedule: Monday‑Friday alternating with Tuesday‑Saturday every other week, 8 AM‑5 PM or 9 AM‑6 PM local time, with occasional holidays and overtime.

Required skills

• Proficiency with Microsoft Office applications.
• Comfort navigating a Windows‑based computer environment.

What we offer

• Full remote work flexibility from any location within the United States.
• Opportunities for professional development and advancement within UnitedHealthcare.
• A supportive environment that rewards performance and provides clear career pathways.