Remote PBM Prior Authorization Pharmacist (Looking for PBM experience)

Clinical Pharmacist Advisor – Medicare (Remote, Contract to hire)

Job Type: Contract to hire
Pay Rate: $53/hour
Location: Fully Remote (U.S.)
Schedule: Business hours between 7:00 AM – 8:00 PM EST Monday–Friday and 7:00 AM – 4:30 PM EST Saturday & Sunday (rotating schedule)
Training Schedule: Monday–Friday, 9:00 AM – 5:30 PM EST for the first 8 weeks

Position Overview

We are seeking a Licensed Registered Pharmacist to join our team as a Clinical Pharmacist Advisor – Medicare . In this role, you will support Medicare Part D members and healthcare providers by reviewing pharmacy benefit requests, evaluating clinical documentation, and ensuring decisions comply with Medicare guidelines and timelines.

This is an excellent opportunity for pharmacists interested in managed care, pharmacy benefit management, and clinical review operations . High-performing contractors may have the opportunity for full-time employment based on performance .

Key Responsibilities

• Review and process Medicare Part D pharmacy benefit requests and appeals
• Ensure accurate case setup by reviewing internal notes, documentation, and fax requests
• Evaluate clinical information and apply professional clinical judgment for decision-making
• Conduct provider outreach to obtain additional clinical details when necessary
• Document case activities clearly and accurately within internal systems
• Ensure compliance with CMS Medicare guidelines and timelines
• Meet departmental productivity and quality standards
• Utilize drug compendia resources and clinical references for appropriate decision-making
• Participate in feedback sessions and development discussions with supervisors

• Required Qualifications

  • Bachelor’s Degree in Pharmacy or PharmD
  • Active Pharmacist License in good standing in the state of residence
  • Strong computer literacy including:
  • • Microsoft Excel
    • Microsoft Word
    • Data entry and multi-system navigation
  • Ability to work independently in a productivity-driven environment
  • Ability to sit and focus for extended periods during scheduled shifts
  • Reliable wired internet connection
  • • Minimum 25 Mbps download / 5 Mbps upload
  • Dedicated quiet workspace for remote work
  • Verifiable High School Diploma or GED

  Preferred Qualifications

  • Experience in Managed Care or PBM (Pharmacy Benefit Management) environments
  • Knowledge of:
  • • Microsoft Access
    • Microsoft PowerPoint
    • Microsoft Visio
  • Experience handling high-volume data entry and multi-screen workflows

  Work Environment

  • Fully remote position
  • Camera use required during training and meetings
  • Data entry and navigating multiple systems across dual monitors
  • Possible outbound provider calls for clinical information

  Important Training & Scheduling Requirements

  • Attendance is critical during the first 8–10 weeks of training
  • Training schedule is Monday–Friday, 9:00 AM – 5:30 PM EST
  • After training, shifts may include one weekend day or rotating weekend coverage
  • Assigned shifts will fall within 7 AM – 8 PM EST

  Hiring Process Requirements

  Candidates must provide the following with their resume:

  • Internet speed test screenshot showing both download and upload speeds (www.speedtest.net) Must have 25 download and 5 upload. MUST SHOW BOTH
  • Screenshot of active pharmacist license showing:
  • • Name
    • License number
    • State
    • Status
    • Valid dates

  Interview Process

  • Virtual interview via Microsoft Teams