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Prior Authorization Clinical Pharmacist - Office Based - WellMed - San Antonio, TX

UnitedHealth Group

San Antonio, TX
Job Code:
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Job Details

Prior Authorization Clinical Pharmacist - Office Based - WellMed - San Antonio, TX(Job Number:705403)

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing your life's best work.(sm)


Under general supervision of the UM Director of Clinical Pharmacy, the UM Clinical Pharmacist is responsible for completing prior authorization functions as needed for WellMed Managed Care Patients. This position will also work with UM nurses as a Clinical Pharmacist and the Medical management P&T Committee. The Clinical Pharmacist is also responsible to follow processes to improve patient care, outcomes, and quality improvement metrics related to CMS HEDIS/Star ratings.


Please note: This is a full time, office based position located at our WellMed office off of Northwest Parkway in San Antonio. 1 Saturday shift every 4-6 weeks is required (4 hour shift).


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Primary Responsibilities:

  • 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 and 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
  • Research drug information to maintain drug knowledge and disease state understanding for application to prior authorization reviews
  • Supports medical management and pharmacy quality initiatives
  • Follow all policies and procedures related to job
  • Performs all other related duties as assigned to meet departmental objectives

Job Pharmacy Clinical Programs
Primary Location US-TX-San Antonio
Other Location 
Organization WellMed Medical Mgmt, Inc
Schedule Full-time
Number of Openings 1
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UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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