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.

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