Clinical Pharmacist Advisor Medicare- Remote {168157}

Clinical Pharmacist Advisor – Medicare (Remote)

Schedule:

Business Hours: Monday through Friday 7:00 AM to 8:00 PM EST and Saturday and Sunday 7:00 AM to 4:30 PM EST

Set rotation required, including weekends based on business needs

Training Schedule:

Monday through Friday 9:00 AM to 5:30 PM EST for the first 8 weeks

No time off permitted during training

Must have a dedicated, quiet workspace free of distractions

Position Overview:

The Clinical Pharmacist Advisor supports Medicare Part D members and providers by ensuring accurate case setup, reviewing clinical information, and making compliant coverage determinations. This role requires strong clinical judgment, attention to detail, and the ability to work efficiently in a fast paced, productivity driven environment. You will collaborate with providers, apply Medicare guidelines, and ensure timely and accurate documentation of all cases.

Key Responsibilities:

• Review Medicare appeals cases for accuracy and completeness

• Evaluate clinical documentation and internal notes for case decisioning

• Perform outbound outreach to providers to obtain additional clinical information

• Ensure compliance with CMS Medicare guidelines and mandated timelines

• Utilize drug compendia resources and internal systems for decision making

• Maintain high productivity and quality standards

• Accurately document all case activity and decisions

• Participate in coaching, feedback sessions, and continuous improvement initiatives

Required Qualifications:

• Bachelor’s degree in Pharmacy or PharmD required

• Active Pharmacist license in good standing in state of residence

• Ability to work independently in a remote environment

• Strong attention to detail and organizational skills

• Verifiable High School Diploma or GED required

Preferred Qualifications:

• Experience in Managed Care or PBM environment

• Knowledge of Microsoft Access, PowerPoint, and Visio

Required Candidate Submissions (Must Be Included on Resume):

• Internet speed test

• Screenshot of active Pharmacist license showing name, state, and expiration date

Additional Details:

• Virtual interviews conducted via Microsoft Teams

• Opportunity for full time employment based on performance

Contact Information:

Taryn Davis

.