Remote Pharmacist - Prior Authorization
A-Line Staffing Solutions
- 2 days ago
- Remote
- $53 Per Hour
- Full-time
Highlights
In this role, you will review and process Medicare Part D pharmacy benefit and appeals requests, ensuring cases are accurately established, clinically reviewed, documented, and completed within required Medicare/CMS timelines. You will work with internal documentation, fax requests, clinical information, drug compendia, Medicare guidance, and providers to obtain the information needed to make accurate decisions.
Numbers & Facts
| Location | (Remote) |
| Job Type | Full-time |
| Industry | Staffing/Employment Agencies |
| Salary | $53 Per Hour |
| Year Founded | 2004 |
| Headquarters | Utica, MI, US |
| Website | http://www.alinestaffing.com/ |
Description
Clinical Pharmacist Advisor – Medicare Part D
Fully Remote | $53 hour | Contract Opportunity with Potential for Full-Time Employment
We are seeking a Clinical Pharmacist Advisor – Medicare Part D to support Medicare members and providers with pharmacy benefit requests. This fully remote position is ideal for a licensed pharmacist with strong clinical judgment, attention to detail, and experience working in a productivity-driven healthcare environment.
Position Overview
In this role, you will review and process Medicare Part D pharmacy benefit and appeals requests, ensuring cases are accurately established, clinically reviewed, documented, and completed within required Medicare/CMS timelines.
You will work with internal documentation, fax requests, clinical information, drug compendia, Medicare guidance, and providers to obtain the information needed to make accurate decisions.
Job Responsibilities
Key Responsibilities
Accurately set up and process Medicare Part D cases and appeals.
Thoroughly review internal notes, fax requests, and clinical documentation for relevant information.
Apply clinical judgment and pharmacy knowledge when reviewing requests.
Evaluate clinical information and make decisions in accordance with applicable CMS Medicare guidelines and drug compendia.
Contact providers when additional clinical information is needed.
Clearly and concisely document case reviews, decisions, and outreach.
Ensure all cases are processed within CMS-mandated timelines.
Maintain departmental productivity, quality, and accuracy standards.
Follow established work instructions and adapt to evolving processes and guidelines.
Utilize multiple computer applications and systems while performing data entry and clinical review.
Participate in development discussions and incorporate feedback from the direct supervisor.
Deliver accurate, timely, and member-focused service throughout the review process.
Qualifications
Required Qualifications
Bachelor's degree in Pharmacy or PharmD required.
Active Pharmacist/RPh license in good standing in your state of residence.
Strong clinical judgment and pharmacy knowledge.
Excellent attention to detail and documentation skills.
Ability to work independently in a productivity-driven environment.
Strong computer and data-entry skills.
Ability to navigate multiple applications while working with two computer screens.
Proficiency with Microsoft Word and Excel.
Must be comfortable working remotely and maintaining focus throughout the entire scheduled shift.
Must have a dedicated, quiet, separate workspace.
Must have wired internet with minimum speeds of 25 Mbps download / 5 Mbps upload.
Preferred Qualifications
Previous experience in a Managed Care or PBM environment.
Experience with Medicare Part D.
Knowledge of Access, PowerPoint, and Visio.
Previous experience involving clinical review, prior authorization, appeals, pharmacy benefits, or healthcare data entry.
Schedule & Training
Training Schedule:
Monday–Friday
9:00 AM–5:30 PM EST
Initial training period is approximately 8–10 weeks.
Attendance is extremely important during training.
Candidates should have no planned vacation/time off during the initial 8 weeks.
Post-Training Schedule:
Business hours are 7:00 AM–8:00 PM EST, Monday–Friday
7:00 AM–4:30 PM EST, Saturday and Sunday
8-hour shifts will be assigned based on business needs.
Schedule will include one weekend day or a weekend rotation.
Work-From-Home Requirements
This is a 100% remote position. Candidates must:
Have a dedicated, quiet, separate workspace.
Have wired internet meeting the minimum 25 Mbps download / 5 Mbps upload requirement.
Be able to sit and focus on work for the duration of the assigned shift without interruptions.
Be comfortable using two monitors and navigating multiple applications.
Be prepared to provide an internet speed-test screenshot with the application/resume.
Provide documentation/screenshot demonstrating an active pharmacist license, including name, state, and expiration/license information.
Candidate Requirements – Please Confirm
Applicants must be able to confirm:
Availability for Monday–Friday, 9:00 AM–5:30 PM EST during the initial training period.
No planned time off that would conflict with the initial 8 weeks of training.
Availability to work an assigned 8-hour shift between 7:00 AM and 8:00 PM EST after training.
Availability for a weekend day or weekend rotation.
A dedicated, quiet, separate work-from-home space.
Wired internet with at least 25 Mbps download and 5 Mbps upload.
Ability to focus and work without interruptions for the full shift.
Previous data-entry/computer-based work experience.
An active Pharmacist license in good standing in the state of residence.
Ability to work independently in a productivity- and quality-driven environment.
Compensation & Opportunity
Pay: $53 per hour
This assignment offers an opportunity for full-time employment contingent upon performance.
Interview Process
Virtual interviews via Microsoft Teams with supervisors.
Candidates should be prepared to discuss their clinical pharmacy experience, Medicare/PBM knowledge, computer skills, data-entry experience, and ability to work independently in a remote environment.
About Company
A-Line Staffing Solutions is a premier staffing company that supplies professionals to the Healthcare, Insurance, Pharmaceutical, and Information Technology industries.
Founded in 2004, A-Line Staffing Solutions has been a leader in matching talented individuals to the jobs that our clients NEED to fill. We are experts at offering creative staffing solutions to employers, and we are hiring every day.
A-Line Staffing can offer short-term, long-term and direct-hire opportunities to professionals across the United States. We hire only the most qualified and talented individuals in the country. Our recruiting, selection and stringent screening processes have strengthened our reputation for delivering quality customer service and unbeatable talent.
For our commissioned clients, A-Line Staffing closely follows the standards and practices established by The Joint Commission. For all of our clients and employees, our commitment to continual improvement combined with a strict code of ethics provides an atmosphere of respect and unparalleled professionalism.
To find out how A-Line Staffing Solutions can share our talent with you, please contact us today. We are eager to include you among our most valued and satisfied clients. If you are a professional and would like to learn more about open opportunities in your area, please contact us today. We are always searching for talented and enthusiastic professionals
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