Pharmacist - Clinical Pharmacist Advisor Medicare

Job Title: Clinical Pharmacist - Medicare / Prior Auth
Location: 100% Remote
Contract: 6 month+ (Possibilities of Extension)


Shift: 7 AM–8 PM EST (rotational schedule)
Pay Range: $50 - $55/hr. on W2
 
Position Overview:
We’re seeking a detail-oriented and clinically driven Clinical Pharmacist Advisor to support Medicare and Prior Authorization operations. In this role, you’ll review, analyze, and process pharmacy benefit requests while ensuring compliance with regulatory and clinical standards. This position requires precision, professionalism, and a commitment to improving patient outcomes—all from the comfort of your home.
Key Responsibilities:

• Review and process Medicare Part D pharmacy benefit requests efficiently and accurately.
• Evaluate clinical information and apply sound clinical judgment based on established criteria and guidelines.
• Interpret internal notes, documentation, and fax requests to confirm complete and compliant case setup.
• Conduct outreach to providers, members, and pharmacies as needed to obtain additional clinical data.
• Make evidence-based determinations using Medicare compendia and formulary policies.
• Ensure all work aligns with HIPAA regulations, CMS guidelines, and organizational standards.

Required Qualifications:

• Active Pharmacist License (any U.S. state).
• Minimum 2 years of clinical experience in pharmacy practice (managed care, prior auth, or clinical review preferred).
• Strong understanding of Medicare Part D and pharmacy benefit management.
• Exceptional attention to detail and ability to work independently in a fast-paced remote environment.
• Proficiency with clinical review tools and electronic systems.

Preferred Qualifications:

• Prior experience with PBMs or health insurance organizations.
• Knowledge of Formulary Management and Utilization Review processes.
• Excellent communication and critical-thinking skills.

 
Schedule & Training:

• Training: 8–10 weeks | Monday–Friday, 9 AM – 5:30 PM EST (no time off during this period).
• Post-training, shifts will be assigned based on business needs, including 1 weekend day or rotational weekends.
• Attendance during training is non-negotiable.