Medical Director - Pharmacy - Remote - UnitedHealth Group : Job Details

Review and sign off on proposed pharmacist denials for preservice outpatient medication requests, after review of medical records when provided Conduct coverage review on some medical cases, based on individual member plan documents, and national and proprietary coverage review guidelines, render coverage determinations, and discuss with requesting providers as needed in peer-to-peer telephone calls Use clinical knowledge in the application and interpretation of medical and pharmacy policy and benefit document language in the process of clinical coverage reviews guidelines Conduct daily clinical review and evaluation of all service requests collaboratively with Clinical Coverage Review staff Provide support for CCR nurses, pharmacists, and non-clinical staff in multiple sites in a manner conducive to teamwork Communicate and collaborate with network and non-network providers in pursuit of accurate and timely benefit determinations for plan participants; educates providers on benefit pl...Medical Director, Director, Medical, Pharmacy, Clinical, Remote, Healthcare