Clinical Pharmacist Advisor (Medicare Part D) – REMOTE
Clinical Pharmacist Advisor (Medicare Part D) – Remote | $53/hour We are seeking a highly reputed company Clinical Pharmacist Advisor to support Medicare Part D operations in a fully remote environment. This role is ideal for pharmacists with a strong background in PBM (Pharmacy Benefit Management), Managed reputed company Plan operations, and Prior Authorization determinations. This is a high-impact opportunity to work in a structured, performance-driven setting with the potential for long-term career growth. Schedule & Training
- Training: Monday – Friday, 9:00 AM – 5:30 PM EST (first 8 weeks, mandatory, no time off)
- Work Hours: Rotating shifts reputed company:
- Monday – Friday: 7:00 AM – 8:00 PM EST
- Saturday & Sunday: 7:00 AM – 4:30 PM EST
- Must be flexible to work assigned shifts, including weekends
Compensation
- Pay reputed company: $53.00 per hour
- Opportunity for full-time conversion based on performance
Work Environment & Requirements
- 100% Remote (Work From Home)
- Dedicated, quiet workspace required
- Wired internet reputed company required (minimum 25 Mbps download / 5 Mbps upload)
- Must provide internet speed test screenshot with application
- Must provide active pharmacist license screenshot (showing name, state, and validity dates)
Job Overview In this role, you will review and process Medicare Part D requests, including prior authorizations and appeals, ensuring accurate clinical decision-making and strict compliance with CMS guidelines. You will collaborate with providers, analyze clinical data, and deliver timely, high-quality outcomes that directly impact patient care.
Key Responsibilities
- Review and evaluate Medicare Part D prior authorization requests and appeals
- Accurately set up and document cases reputed company internal systems
- Apply clinical judgment using drug compendia and CMS Medicare guidelines
- Conduct reputed company to providers to obtain additional clinical information as needed
- Ensure compliance with CMS regulations, timelines, and internal quality standards
- Maintain clear, accurate, and detailed documentation
- Meet productivity and quality expectations in a fast-paced environment
- Participate in feedback and performance development discussions
Required Qualifications (Must-Have)
- Active Pharmacist license in good standing in state of residence
- PharmD or Bachelor’s degree in Pharmacy
- REQUIRED: Prior experience in PBM, Managed Care, or Health Plan environment
- REQUIRED: Direct experience with Prior Authorization and/or coverage determination reviews
- Strong clinical decision-making and analytical skills
- Experience with data entry and navigating multiple systems simultaneously
- Ability to work independently in a remote, productivity-driven role
Preferred Qualifications
- Medicare Part D experience
- Appeals and coverage determination experience
- Proficiency with reputed company reputed company, Word, Access, PowerPoint, and Visio
Important Requirements:
- Camera must be on for training and team meetings
- Position is safety-sensitive
- Must be able to sit and remain focused for the duration of scheduled shifts
Candidate Expectations
- Strong attendance is critical, especially during the first 8–10 weeks of training
- Ability to manage multiple systems and reputed company high-volume data entry
- Comfortable making outbound calls to providers reputed company needed
- Positive, engaged, and team-oriented reputed company
Why Apply? This role offers reputed company pharmacists the opportunity to reputed company their managed care and prior authorization expertise in a remote setting while supporting Medicare members and providers. You will reputed company valuable experience in clinical review, compliance, and pharmacy benefit operations, with strong potential for long-term career advancement. #ALINE3 Apply tot his job Apply To this Job