NEW JOB OPENING
CLINICAL PHARMACIST ADVISOR MEDICARE
IN Remote, USA!

Required Education

• Bachelor’s degree in pharmacy



Preferred Education

• Doctor of Pharmacy (Pharm.D.)



Required License/Certification

• Active pharmacy license in good standing in the state of residence



Required Qualifications/Skills/Experience

• Minimum 02 years of working experience as a clinical pharmacist

• Clinical pharmacy knowledge and judgment

• Ability to review clinical information and make accurate, evidence-based decisions

• Ability to interpret and apply Medicare guidelines and CMS requirements

• Ability to use drug compendia resources and evolving work instructions

• Ability to accurately document case reviews and clinical decisions

• Knowledge of Medicare Part D

• Ability to meet CMS-mandated timelines and departmental productivity and quality standards



Preferred Qualifications/Skills/Experience

• Previous experience in a Managed Care or PBM environment



Clinical Pharmacist Advisor Medicare Overview

• The Clinical Pharmacist Advisor Medicare directly supports Medicare Part D members and providers with requests related to their pharmacy benefits

• This role is responsible for accurately setting up member cases, reviewing clinical information to make decisions, and conducting provider outreach when additional information is needed

• The position requires accurate and timely documentation of Medicare Part D requests in compliance with Medicare guidelines, drug compendia, CMS guidance, and applicable work instructions

• The role requires clinical judgment, attention to detail, adherence to CMS-mandated timelines, and commitment to departmental productivity and quality standards

• This position provides an opportunity to initiate a career with a leading healthcare company while promoting a best-in-class service experience



Job Duties

• Ensure the accuracy of case setup and clinical review of Medicare appeals cases

• Thoroughly review internal notes and fax requests for pertinent information

• Provide clear and concise documentation

• Contact providers when necessary to obtain additional clinical details required for case decisions

• Adhere to work instructions and Medicare guidelines to ensure proper case processing

• Comply with CMS-mandated timelines

• Meet departmental productivity and quality standards

• Apply clinical judgment and knowledge effectively

• Utilize drug compendia resources, evolving work instructions, and CMS Medicare guidance

• Review clinical information and complete timely and accurate documentation of Medicare Part D requests

• Promote a best-in-class service experience for Medicare Part D members and providers

• **Only those lawfully authorized to work in the designated country associated with the position will be considered.**

• **Please note that all Position start dates and duration are estimates and may be reduced or lengthened based upon a client’s business needs and requirements.**