Pharmacist - Clinical Pharmacist Advisor Medicare

UPDATE: Please inform your candidates that:

As part of the hiring process, we require all new hires to be on camera during meetings. This will include the training portion as well as any meetings with supervisor or team meetings.



On the top of each resume.:

•Must provide internet speed test on the resume (INCLUDE SCREEN SHOT) - www.speedtest.net (make sure both download/upload speed is shown)

•Must have active license in the state of residence listed on the resume (INCLUDE SCREENSHOT OF LICENSE. MUST INCLUDE DATES/NAME/STATE/ETC. TO SHOW IT IS ACTIVE)



Shift: Business Hours are 7am - 8pm EST Monday - Friday and 7am - 430pm EST Sat and Sunday. Set Rotation.



Virtual interviews with supervisors via Teams.



•IMPORTANT*

-Knowledge of Access, Power Point, and Visio is preferable.

-Must be computer literate knowledge of Excel and Word.

-Licensed Registered Pharmacist in state of residence



Please review the below with candidate, complete, and copy on top of resume:

1. Attendance is extremely important, especially during the initial 8-10 weeks of training. The new hire must be available M-F from 9am-5:30pm EST for the first 8 weeks (no vacation time planned). Do you have any conflicts with the training schedule or time off planned during assignment duration?

2. After training, shifts will be assigned based on business needs and will include either 1 weekend day, or a weekend rotation*** Do you have any conflicts working an assigned 8-hour shift between 7 AM to 8PM EST?

3. This is a work from home (WFH) position for which you must have a dedicated quiet, separate space to work. Do you have a dedicated, quiet separate space in which to work?

4. Do you have wired internet meeting 25 mbps min download and 5 mbps minimum upload speed? MUST INCLUDE SCREENSHOT OF INTERNET SPEED AT TOP OF RESUME.

5. Must be able to sit and focus on work for the duration of shift. Are you able to sit and focus with no interruptions for entire shift?

6. Data entry and navigating multiple computer applications while utilizing two screens is the primary function of job (possible outbound calls needed). A job history demonstrating this is recommended. Do you have data entry experience?

7. Do you have an active Pharmacist license in good standing in the state you live in? MUST INCLUDE SCREENSHOT OF ACTIVE PHARMACY LICENSE AT TOP OF RESUME.

8. Are you able to work independently and successfully in a data entry, productivity driven role?

9. As a company we strive for a team that is engaged and positive so candidates that demonstrate this would be ideal. Do you feel you have the engagement and positive attitude to work this assignment?



As an RPh Advisor you will be directly supporting Medicare Part D members and providers with requests related to their pharmacy benefits. You will be responsible for ensuring cases are accurately set up for our members, review clinical information for decisioning the request, performing outreach to providers for more information when needed, and ensuring accurate decisions that comply with compendia and Medicare guidance and timelines. This is a great opportunity to initiate a career with a leading healthcare company by reviewing information and completing timely and accurate documentation of all Medicare Part D requests, in compliance with Medicare guidelines, while promoting a best-in-class service experience.



Opportunity for full-time employment contingent on performance.



Position Summary:



As a Clinical Pharmacist Advisor Medicare you will be directly supporting Medicare Part D members and providers with requests related to their pharmacy benefits. You will be responsible for ensuring cases are accurately set up for our members, review clinical information for decisioning the request, performing outreach to providers for more information when needed, and ensuring accurate decisions that comply with compendia and Medicare guidance and timelines. This is a great opportunity to initiate a career with a leading healthcare company by reviewing information and completing timely and accurate documentation of all Medicare Part D requests, in compliance with Medicare guidelines, while promoting a best-in-class service experience.



Duties:



The role involves ensuring the accuracy of case setup and clinical review of Medicare appeals cases by thoroughly reviewing internal notes or fax requests for pertinent information, providing clear and concise documentation, and contacting providers when necessary to obtain clinical details for case decisions. It requires adherence to work instructions and Medicare guidelines to ensure proper case processing. The position also demands compliance with CMS-mandated timelines, as well as departmental productivity and quality standards. Clinical judgment and knowledge must be applied effectively, utilizing drug compendia resources, evolving work instructions, and CMS Medicare guidance. Additionally, the role includes participating in development discussions and receiving feedback from the direct supervisor to support continuous improvement.



Experience:



Previous experience in Managed Care/PBM environment (preferred)



Education:



Bachelor's degree in pharmacy or Pharm D. required. Must have an active license in good standing in state of residence.