Pharmacist - Clinical Pharmacist Advisor Medicare

Job Title: Pharmacist - Clinical Pharmacist Advisor Medicare
Location: Remote, RI 02895
Duration: 6 Months+ (Possibilities of Extension)


Pay Rate: $53/hr. on W2
 
Shift: Business Hours are 7:00 AM – 8:00 PM EST Monday – Friday and 7:00 AM – 4:30 PM EST Saturday and Sunday (Set Rotation Required)
Interview Process: Virtual via Microsoft Teams
 
!! IMPORTANT REQUIREMENTS – MUST INCLUDE ON TOP OF RESUME !!

1. Internet Speed Test Screenshot – Use www.speedtest.net and include a screenshot showing both download (min 25 Mbps) and upload (min 5 Mbps) speeds.
2. Screenshot of Active Pharmacist License – Must include license number, full name, state of residence, and expiration date. License must be active and in good standing in the state listed on resume.

 
Candidate Pre-Screen Questionnaire – MUST BE COMPLETED AND COPIED TO TOP OF RESUME

1. Attendance is extremely important, especially during the initial 8–10 weeks of training. The new hire must be available Monday–Friday, 9:00 AM–5:30 PM EST for the first 8 weeks. (No planned vacation time during training.)
   • Do you have any conflicts with this training schedule or any time off planned during the assignment?
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 7:00 AM and 8:00 PM EST?
3. This is a Work From Home (WFH) position.
   • Do you have a dedicated, quiet, and separate space to work from home?
4. Do you have wired internet with minimum speeds of 25 Mbps download and 5 Mbps upload? (Screenshot required.)
5. This role requires extended focus.
   • Are you able to sit and focus for the entire duration of your shift without interruptions?
6. Primary job function is data entry and navigating multiple applications on dual monitors.
   • Do you have relevant data entry experience?
7. You must hold an active Registered Pharmacist license in your state of residence.
   • Is your license active and in good standing? (Screenshot required.)
8. This is a productivity-driven role.
   • Are you able to work independently and remain focused?
9. We seek engaged and positive team members.
   • Do you feel you have the engagement and positive attitude to succeed in this role?

 
Position Summary:
As a Clinical Pharmacist Advisor – Medicare, you will support Medicare Part D members and providers with pharmacy benefit requests. Responsibilities include accurate case setup, clinical review of requests, and provider outreach. You’ll ensure decisions are made in accordance with drug compendia, CMS guidance, and internal protocols, while providing a best-in-class service experience. This role is ideal for those seeking a long-term career with a leading healthcare company.
 
Key Duties:

• Ensure cases are accurately set up in the system.
• Perform clinical reviews of Medicare appeal cases based on internal documentation or faxed requests.
• Document decisions clearly and concisely.
• Contact providers to obtain clinical information when needed.
• Adhere to CMS-mandated timelines, quality standards, and productivity metrics.
• Use clinical judgment to determine decisions based on compendia, work instructions, and Medicare guidance.
• Participate in performance improvement discussions and feedback sessions with supervisor.

 
Required Experience:

• Experience in Managed Care or PBM environment is preferred.

 
Required Education & Credentials:

• Bachelor’s Degree in Pharmacy or Doctor of Pharmacy (PharmD) is required.
• Must have an active Registered Pharmacist license in good standing in your state of residence.
• Screenshot of license must be included at the top of the resume.

 
Technical & Professional Skills:

• Proficient in Microsoft Word and Excel.
• Knowledge of Access, PowerPoint, and Visio is preferable.
• Must be computer literate and able to manage multiple applications simultaneously.
• Strong communication, problem-solving, and time management skills.