Job Description
Job Description
Clinical Pharmacist Advisor - Medicare Part D (REMOTE)
Location: 100% Remote (U.S.)
Pay Rate: $53.00/hr
Schedule: Set rotation within business hours (see below)
Opportunity: Contract with potential for full-time conversion
About the Role
We are hiring 50 Remote Clinical Pharmacist Advisors to support Medicare Part D members and providers in a fast-paced, high-volume, production-driven environment. This role is ideal for pharmacists with prior authorization, managed care, or PBM experience who thrive in a structured, remote setting.
As a Clinical Pharmacist Advisor, you will review pharmacy benefit requests, make clinical determinations, and ensure compliance with CMS and Medicare guidelines while delivering best-in-class service.
- Key Responsibilities
- Review and process prior authorizations, coverage determinations, and appeals
- Evaluate clinical documentation to support approval/denial decisions
- Ensure all cases meet Medicare Part D and CMS compliance standards
- Conduct provider outreach to obtain additional clinical information
- Document all decisions clearly and accurately in system workflows
- Manage high-volume queues while meeting productivity and quality metrics
- Apply clinical knowledge using drug compendia and established guidelines Required Qualifications
- Active Pharmacist license in state of residence (in good standing)
- PharmD or Bachelor's Degree in Pharmacy
- Strong computer skills (Excel, Word required; Access, PowerPoint, Visio preferred)
- Experience with data entry, dual screens, and multiple systems
- Ability to work independently in a productivity-driven remote environment
- Strong attention to detail and documentation accuracy Preferred Experience
- Managed Care / PBM experience
- Prior Authorization, Coverage Determinations, or Appeals
- Medicare Part D knowledge and CMS guideline familiarity
- Remote pharmacist or high-volume review experience
- Retail + Managed Care hybrid background Schedule & Training Requirements
- Training: Monday-Friday, 9:00 AM - 5:30 PM EST (first 8 weeks - no time off allowed)
- Post-Training Schedule:
- Business Hours: 7:00 AM - 8:00 PM EST (Mon-Fri)
- Weekends: 7:00 AM - 4:30 PM EST
- Must be flexible to work assigned 8-hour shifts, including weekends
- Work Environment Requirements (MANDATORY)
- Dedicated, quiet, private workspace
- Wired internet connection:
- Minimum 25 Mbps download / 5 Mbps upload
- Speed test screenshot required (must be included on resume)
- Ability to remain on camera during training and team meetings
- Ability to sit and focus for full shift with minimal interruptions Submission Requirements (MUST BE INCLUDED ON RESUME)
- Screenshot of internet speed test ( www.speedtest.net )
- Screenshot of active pharmacist license (showing name, state, expiration)
- Completed candidate questionnaire (see below) Candidate Pre-Screen Questionnaire (Include with Submission)
- Are you available for full-time training (M-F, 9-5:30 EST) for 8 weeks with no time off?
- Can you work any assigned 8-hour shift between 7 AM - 8 PM EST, including weekends?
- Do you have a dedicated, quiet workspace for remote work?
- Do you have wired internet meeting 25/5 Mbps requirements?
- Can you sit and focus for the entire shift without interruptions?
- Do you have experience with data entry and multiple systems/screens?
- Do you have an active pharmacist license in your state of residence?
- Are you comfortable working independently in a productivity-based role?
- Do you bring a positive, engaged attitude to a team environment?
Job Requirements
Clinical Pharmacist Advisor - Medicare Part D (REMOTE)
Location: 100% Remote (U.S.)
Pay Rate: $53.00/hr
Schedule: Set rotation within business hours (see below)
Opportunity: Contract with potential for full-time conversion
About the Role
We are hiring 50 Remote Clinical Pharmacist Advisors to support Medicare Part D members and providers in a fast-paced, high-volume, production-driven environment. This role is ideal for pharmacists with prior authorization, managed care, or PBM experience who thrive in a structured, remote setting.
As a Clinical Pharmacist Advisor, you will review pharmacy benefit requests, make clinical determinations, and ensure compliance with CMS and Medicare guidelines while delivering best-in-class service.
- Key Responsibilities
- Review and process prior authorizations, coverage determinations, and appeals
- Evaluate clinical documentation to support approval/denial decisions
- Ensure all cases meet Medicare Part D and CMS compliance standards
- Conduct provider outreach to obtain additional clinical information
- Document all decisions clearly and accurately in system workflows
- Manage high-volume queues while meeting productivity and quality metrics
- Apply clinical knowledge using drug compendia and established guidelines Required Qualifications
- Active Pharmacist license in state of residence (in good standing)
- PharmD or Bachelor's Degree in Pharmacy
- Strong computer skills (Excel, Word required; Access, PowerPoint, Visio preferred)
- Experience with data entry, dual screens, and multiple systems
- Ability to work independently in a productivity-driven remote environment
- Strong attention to detail and documentation accuracy Preferred Experience
- Managed Care / PBM experience
- Prior Authorization, Coverage Determinations, or Appeals
- Medicare Part D knowledge and CMS guideline familiarity
- Remote pharmacist or high-volume review experience
- Retail + Managed Care hybrid background Schedule & Training Requirements
- Training: Monday-Friday, 9:00 AM - 5:30 PM EST (first 8 weeks - no time off allowed)
- Post-Training Schedule:
- Business Hours: 7:00 AM - 8:00 PM EST (Mon-Fri)
- Weekends: 7:00 AM - 4:30 PM EST
- Must be flexible to work assigned 8-hour shifts, including weekends
- Work Environment Requirements (MANDATORY)
- Dedicated, quiet, private workspace
- Wired internet connection:
- Minimum 25 Mbps download / 5 Mbps upload
- Speed test screenshot required (must be included on resume)
- Ability to remain on camera during training and team meetings
- Ability to sit and focus for full shift with minimal interruptions Submission Requirements (MUST BE INCLUDED ON RESUME)
- Screenshot of internet speed test ( www.speedtest.net )
- Screenshot of active pharmacist license (showing name, state, expiration)
- Completed candidate questionnaire (see below)
- Candidate Pre-Screen Questionnaire (Include with Submission)
- Are you available for full-time training (M-F, 9-5:30 EST) for 8 weeks with no time off?
- Can you work any assigned 8-hour shift between 7 AM - 8 PM EST, including weekends?
- Do you have a dedicated, quiet workspace for remote work?
- Do you have wired internet meeting 25/5 Mbps requirements?
- Can you sit and focus for the entire shift without interruptions?
- Do you have experience with data entry and multiple systems/screens?
- Do you have an active pharmacist license in your state of residence?
- Are you comfortable working independently in a productivity-based role?
- Do you bring a positive, engaged attitude to a team environment?
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