NEW JOB OPENING
CLINICAL PHARMACIST-MEDICARE PART D APPEALS & CLINICAL REVIEW
IN Remote, USA!

Required Education:

• Bachelor’s degree in pharmacy



Preferred Education:

• PharmD



Required License/Certification:

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



Required Qualifications/Skills/Experience:

• Previous experience reviewing clinical information and making accurate pharmacy-related decisions

• Experience with data entry and navigating multiple computer applications simultaneously

• Strong computer literacy, including Microsoft Excel and Word

• Ability to work independently in a productivity-driven environment

• Ability to sit and maintain focus throughout the full work shift with minimal interruptions

• Strong attention to detail and ability to maintain accuracy and quality standards

• Ability to follow work instructions, Medicare guidelines, and CMS-mandated timelines

• Ability to work from home with a dedicated, quiet, separate workspace

• Wired internet with minimum speeds of 25 Mbps download and 5 Mbps upload

• Ability to work assigned 8-hour shifts between 7:00 AM and 8:00 PM EST, Monday through Friday, with weekend requirements based on business needs

• Ability to attend required training Monday through Friday, 9:00 AM–5:30 PM EST for the first 8 weeks

• No planned vacation or time off during the initial 8 weeks of training



Preferred Qualifications/Skills/Experience:

• Previous experience in a Managed Care or PBM environment

• Knowledge of Access, PowerPoint, and Visio

• Experience with Medicare Part D appeals or pharmacy benefit requests

• Experience using drug compendia resources

• Previous experience with clinical documentation and provider outreach



Clinical Pharmacist – Medicare Part D Appeals & Clinical Review Overview:

• As a Clinical Pharmacist Advisor – Medicare, you will support Medicare Part D members and providers by accurately setting up cases, reviewing clinical information, making appropriate decisions, and completing timely documentation in accordance with Medicare guidelines

• The role involves reviewing internal notes and fax requests for pertinent clinical information, contacting providers when additional information is needed, and applying clinical judgment and pharmacy knowledge to case decisions

• You will use drug compendia resources, evolving work instructions, and CMS Medicare guidance to ensure cases are processed accurately and within required timelines

• The position requires strong attention to detail, computer proficiency, independent decision-making, and the ability to work effectively in a productivity- and quality-driven remote environment

• The role also includes participating in development discussions and receiving feedback from the direct supervisor to support continuous improvement

• This position provides an opportunity to support Medicare Part D operations while delivering accurate and timely service to members and providers



Job Duties:

• Ensure accurate setup of Medicare appeals cases

• Review internal notes and fax requests for pertinent clinical information

• Review clinical information to support appropriate case decisioning

• Contact providers when additional clinical information is required

• Complete clear, concise, accurate documentation for Medicare Part D requests

• Apply clinical judgment and pharmacy knowledge to case decisions

• Utilize drug compendia resources and CMS Medicare guidance

• Follow established work instructions and evolving departmental procedures

• Ensure compliance with CMS-mandated timelines

• Meet departmental productivity and quality standards

• Support accurate and timely processing of Medicare Part D requests

• Participate in development discussions and incorporate feedback from the direct supervisor

• Navigate multiple computer applications while utilizing two screens

• Perform data entry and possible outbound calls as needed



#CV1

• **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.**