Remote Clinical Pharmacist Advisor- Medicare

Job Title: Remote Clinical Pharmacist Advisor – Medicare (Contract-to-Hire)

Location: Remote (Must reside and be licensed in state of residence)
Pay Rate: $53/hour
Job Type: Contract-to-Hire
Schedule: Business Hours are 7am - 8pm EST Monday - Friday and 7am - 430pm EST Sat and Sunday. Set Rotation

Start Date : May 11th or 18th

Position Overview

We are seeking an experienced Clinical Pharmacist Advisor – Medicare to join a high-performing, remote clinical review team. This role focuses on prior authorizations, coverage determinations, and Medicare Part D reviews in a fast-paced, production-driven environment.

This is an excellent opportunity for pharmacists with managed care, PBM, or Medicare experience who thrive in a remote, independent workflow setting and are comfortable handling high-volume clinical case reviews .

Schedule

• Business Hours:
• Monday – Friday: 7:00 AM – 8:00 PM EST
• Saturday & Sunday: 7:00 AM – 4:30 PM EST
• Rotation: Set schedule (may include weekends)
• Training Schedule: Monday – Friday, 9:00 AM – 5:30 PM EST

Key Responsibilities

• Perform prior authorization and coverage determination reviews in accordance with clinical guidelines and CMS regulations
• Evaluate medication requests, including formulary exceptions, step therapy, and quantity limits
• Process appeals and denial reviews with accurate clinical documentation
• Apply Medicare Part D knowledge to ensure compliance and timely decision-making
• Communicate with providers to obtain necessary clinical information and explain determinations
• Document decisions clearly, including rationale for approvals or denials
• Maintain productivity and quality standards in a high-volume, queue-based environment

Required Qualifications

• Bachelor’s Degree in Pharmacy or PharmD
• Active Pharmacist License in good standing in state of residence
• Minimum 1+ year of experience in managed care, PBM, or prior authorization review
• Strong knowledge of Medicare Part D and pharmacy benefit structures
• Experience with:
• Prior authorizations
• Coverage determinations & appeals
• Clinical criteria and formulary reviews

Preferred Experience

• Previous experience in PBM environments (e.g., Medicare or commercial plans)
• Background in organizations such as CVS/Caremark, OptumRx, Cigna, Walgreens, or similar
• Combination of retail pharmacy + managed care experience
• Experience working in a remote, production-based role

Key Skills & Competencies

• Ability to manage high-volume case review queues with speed and accuracy
• Strong clinical decision-making and documentation skills
• Excellent provider communication and collaboration
• High level of attention to detail and compliance adherence
• Comfortable working independently in a remote environment with minimal supervision
• Strong computer proficiency and ability to navigate multiple systems simultaneously

What Makes a Strong Candidate

Successful candidates typically bring:

• Proven experience in Medicare pharmacy benefit review work
• A track record of handling time-sensitive clinical decisions
• Comfort working in remote, metrics-driven environments
• Ability to clearly communicate clinical decisions and alternatives to providers
• Readiness to hit the ground running with minimal ramp-up time

Why Join Us?

• Fully remote opportunity
• Competitive hourly pay with contract-to-hire potential
• Structured training and support
• Opportunity to work with a leading clinical review team in the Medicare space INDJP

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