Job Title: Clinical Pharmacist Advisor – Medicare (Remote)Pay: $53 an hour paid biweekly.Job Type: Full-Time, Remote (Never Onsite)Training Schedule: Monday–Friday, 9:00 AM – 5:30 PM ESTJob SummaryWe are seeking a Clinical Pharmacist Advisor – Medicare to support Medicare Part D members and providers with requests related to pharmacy benefits. In this role, you will ensure the accuracy of case setup, perform clinical reviews of Medicare appeals, and make decisions in accordance with compendia, Medicare guidelines, and CMS-mandated timelines. This is an excellent opportunity to join a leading healthcare organization and make a direct impact on patient care while working fully remote.Responsibilities
Ensure accurate setup and clinical review of Medicare appeals cases.
Review internal notes, fax requests, and other documentation for pertinent information.
Contact providers when necessary to obtain additional clinical details.
Document all case activity clearly and concisely in compliance with departmental and Medicare requirements.
Adhere to Medicare guidelines, CMS timelines, and departmental productivity/quality standards.
Apply clinical judgment and knowledge using drug compendia resources, evolving work instructions, and Medicare guidance.
Participate in performance discussions and integrate feedback to improve processes.
Support members and providers by delivering a best-in-class service experience.
Qualifications
Bachelor’s degree in Pharmacy or Doctor of Pharmacy (PharmD) required.
Active, unrestricted pharmacist license in state of residence (in good standing).
Previous experience in a Managed Care or Pharmacy Benefit Management (PBM) environment preferred.
Strong knowledge of Medicare Part D guidelines and compendia.
Excellent clinical judgment and decision-making skills.
Strong attention to detail with the ability to meet strict deadlines.
Exceptional written and verbal communication skills.
Benefits
Fully remote – no onsite requirement.
Comprehensive training provided.
Opportunity to work with a respected leader in healthcare.
Collaborative and supportive work environment.
Schedule:
Training: Monday–Friday, 9:00 AM – 5:30 PM EST
Full-time position after training
Feel free to reach out to Tyler at tscott@alinestaffing.com
