Clinical Pharmacist Advisor (Medicare Part D) – REMOTE

Location: 100% Remote (U.S.)
Pay Rate: $53.00/hr
Schedule: Set rotation within business hours (see below)

Opportunity: Contract with potential for full-time conversion

We are hiring 50 Remote Clinical Pharmacist Advisors to support Medicare Part D members and providers in a fast-paced, high-volume, production-driven environment. This role is ideal for pharmacists with prior authorization, managed care, or PBM experience who thrive in a structured, remote setting.

As a Clinical Pharmacist Advisor, you will review pharmacy benefit requests, make clinical determinations, and ensure compliance with CMS and Medicare guidelines while delivering best-in-class service.

• Review and process prior authorizations, coverage determinations, and appeals

• Evaluate clinical documentation to support approval/denial decisions

• Ensure all cases meet Medicare Part D and CMS compliance standards

• Conduct provider outreach to obtain additional clinical information

• Document all decisions clearly and accurately in system workflows

• Manage high-volume queues while meeting productivity and quality metrics

• Apply clinical knowledge using drug compendia and established guidelines

• Active Pharmacist license in state of residence (in good standing)

• PharmD or Bachelor’s Degree in Pharmacy

• Strong computer skills (Excel, Word required; Access, PowerPoint, Visio preferred)

• Experience with data entry, dual screens, and multiple systems

• Ability to work independently in a productivity-driven remote environment

• Strong attention to detail and documentation accuracy

• Managed Care / PBM experience

• Prior Authorization, Coverage Determinations, or Appeals

• Medicare Part D knowledge and CMS guideline familiarity

• Remote pharmacist or high-volume review experience

• Retail + Managed Care hybrid background

• Training: Monday–Friday, 9:00 AM – 5:30 PM EST (first 8 weeks – no time off allowed)

• Post-Training Schedule:

  • Business Hours: 7:00 AM – 8:00 PM EST (Mon–Fri)

  • Weekends: 7:00 AM – 4:30 PM EST

  • Must be flexible to work assigned 8-hour shifts, including weekends

• Dedicated, quiet, private workspace

• Wired internet connection:

  • Minimum 25 Mbps download / 5 Mbps upload

  • Speed test screenshot required (must be included on resume)

• Ability to remain on camera during training and team meetings

• Ability to sit and focus for full shift with minimal interruptions

• Screenshot of internet speed test (

  www.speedtest.net
  )

• Screenshot of active pharmacist license (showing name, state, expiration)

• Completed candidate questionnaire (see below)

1. Are you available for full-time training (M–F, 9–5:30 EST) for 8 weeks with no time off?

2. Can you work any assigned 8-hour shift between 7 AM – 8 PM EST, including weekends?

3. Do you have a dedicated, quiet workspace for remote work?

4. Do you have wired internet meeting 25/5 Mbps requirements?

5. Can you sit and focus for the entire shift without interruptions?

6. Do you have experience with data entry and multiple systems/screens?

7. Do you have an active pharmacist license in your state of residence?

8. Are you comfortable working independently in a productivity-based role?

9. Do you bring a positive, engaged attitude to a team environment?

We are hiring 50 Remote Clinical Pharmacist Advisors to support Medicare Part D members and providers in a fast-paced, high-volume, production-driven environment. This role is ideal for pharmacists with prior authorization, managed care, or PBM experience who thrive in a structured, remote setting.

As a Clinical Pharmacist Advisor, you will review pharmacy benefit requests, make clinical determinations, and ensure compliance with CMS and Medicare guidelines while delivering best-in-class service.

• Review and process prior authorizations, coverage determinations, and appeals

• Evaluate clinical documentation to support approval/denial decisions

• Ensure all cases meet Medicare Part D and CMS compliance standards

• Conduct provider outreach to obtain additional clinical information

• Document all decisions clearly and accurately in system workflows

• Manage high-volume queues while meeting productivity and quality metrics

• Apply clinical knowledge using drug compendia and established guidelines