Clinical Pharmacist Advisor - Medicare Part D (REMOTE)

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?