Clinical Pharmacist Advisor – Medicare (Remote)

Job Posting: Clinical Pharmacist Advisor – Medicare (Remote)

Position Title: Clinical Pharmacist Advisor – Medicare
Location: 100% Remote (U.S. Based)
Start Date: July 20, 2026
Pay Rate: $53.00/hr - 55.00

Opportunity: Potential for Full-Time Conversion Based on Performance

All meetings require camera participation.
As part of the hiring process and assignment expectations, candidates must be comfortable being on camera during training, supervisor meetings, and team meetings.

• Offer Extended By: ASAP
• Clear to Start Deadline: Prior to July 10, 2026
• Start Date: July 20, 2026

Please DO NOT resubmit candidates previously submitted to CVS ramp roles (2023–2025) or candidates rejected by the hiring team.

Duration: First 8–10 weeks

Monday – Friday
9:00 AM – 5:30 PM EST

No time off permitted during training

Attendance is critical during onboarding and training.

Set rotational schedule based on business needs:

Monday – Friday:
7:00 AM – 8:00 PM EST

Saturday & Sunday:
7:00 AM – 4:30 PM EST

Candidates must be flexible to work:

• Assigned 8-hour shifts
• Weekend rotation OR one weekend day consistently
• Productivity-driven remote workflow

The Clinical Pharmacist Advisor – Medicare supports Medicare Part D members and providers by reviewing and processing pharmacy benefit requests, Medicare appeals, and clinical authorization cases while ensuring compliance with CMS Medicare regulations, compendia guidance, productivity metrics, and quality standards.

This role requires strong clinical judgment, exceptional documentation skills, and the ability to independently review complex clinical information to support timely, accurate case decisions.

• Review Medicare Part D pharmacy appeals and benefit requests
• Ensure accurate clinical case setup and documentation
• Review internal notes, faxes, and supporting clinical documentation
• Contact providers to obtain additional clinical details when required
• Apply CMS Medicare guidelines and drug compendia resources
• Ensure compliance with required turnaround timelines
• Maintain departmental productivity and quality metrics
• Navigate multiple systems and perform high-volume data entry
• Participate in coaching, feedback, and performance development discussions
• Collaborate professionally with internal teams and providers

• Active Registered Pharmacist license in state of residence (must be active and in good standing)
• Bachelor of Pharmacy or PharmD required
• Previous Managed Care / PBM experience preferred
• Strong Medicare Part D knowledge preferred
• Excellent clinical judgment and documentation accuracy
• Advanced computer literacy
• Experience with:
  • Microsoft Excel
  • Word
  • Access (preferred)
  • PowerPoint (preferred)
  • Visio (preferred)
• Ability to work independently in a productivity-driven remote environment

Candidates must have:

✔ Dedicated private workspace
✔ Quiet, distraction-free environment
✔ Wired internet connection only
✔ Minimum internet speed:

• 25 Mbps Download
• 5 Mbps Upload

✔ Dual-monitor workflow capability
✔ Ability to sit and focus for full scheduled shift

Must appear at TOP of resume submission:

Must include screenshot from:

Must clearly show:

• Download speed
• Upload speed
• Date/time visible

Must clearly display:

• Candidate name
• License number
• State of residence
• Expiration date
• Active status

1. Training Availability
Do you have any conflicts with mandatory training ( M–F, 9:00 AM–5:30 PM EST for 8–10 weeks ) or planned time off during assignment?

2. Shift Flexibility
Are you able to work assigned 8-hour shifts between 7:00 AM–8:00 PM EST , including weekend rotation or one weekend day?

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

4. Wired Internet
Do you have wired internet meeting minimum 25 Mbps download / 5 Mbps upload ?
(Attach screenshot)

5. Shift Focus Requirement
Can you remain seated and focused with no interruptions for the full shift?

6. Data Entry Experience
Do you have experience navigating multiple systems and performing high-volume data entry using dual screens?

7. Active Pharmacist License
Do you have an active pharmacist license in good standing in your state of residence?

8. Independent Productivity
Are you comfortable working independently in a productivity-driven environment?

9. Positive Team Engagement
Do you demonstrate a positive, collaborative, and engaged work style?

Virtual Teams Interview with CVS Supervisors

Candidates must:

• Present professionally
• Have camera enabled
• Be prepared for behavioral and workflow-based questions

We are seeking pharmacists who are:

• Detail-oriented
• Clinically sharp
• Medicare/PBM knowledgeable
• Comfortable with remote structured workflows
• Highly productive
• Positive and coachable
• Strong written/documentation communicators

Position Summary

The Clinical Pharmacist Advisor – Medicare supports Medicare Part D members and providers by reviewing and processing pharmacy benefit requests, Medicare appeals, and clinical authorization cases while ensuring compliance with CMS Medicare regulations, compendia guidance, productivity metrics, and quality standards.

This role requires strong clinical judgment, exceptional documentation skills, and the ability to independently review complex clinical information to support timely, accurate case decisions.

• Review Medicare Part D pharmacy appeals and benefit requests
• Ensure accurate clinical case setup and documentation
• Review internal notes, faxes, and supporting clinical documentation
• Contact providers to obtain additional clinical details when required
• Apply CMS Medicare guidelines and drug compendia resources
• Ensure compliance with required turnaround timelines
• Maintain departmental productivity and quality metrics
• Navigate multiple systems and perform high-volume data entry
• Participate in coaching, feedback, and performance development discussions
• Collaborate professionally with internal teams and providers