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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.

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.

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:

1. Availability for Monday–Friday, 9:00 AM–5:30 PM EST during the initial training period.
2. No planned time off that would conflict with the initial 8 weeks of training.
3. Availability to work an assigned 8-hour shift between 7:00 AM and 8:00 PM EST after training.
4. Availability for a weekend day or weekend rotation.
5. A dedicated, quiet, separate work-from-home space.
6. Wired internet with at least 25 Mbps download and 5 Mbps upload.
7. Ability to focus and work without interruptions for the full shift.
8. Previous data-entry/computer-based work experience.
9. An active Pharmacist license in good standing in the state of residence.
10. 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.