High Paying Pharmacist Clinical Pharmacist Advisor Medicare Bulk Openings across US.

Job ID: 26-100307

Job Title: ‘Pharmacist –Clinical Pharmacist Advisor Medicare’

Position Type: Full-Time Contract Role
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Location: Work from home

Work Type: Remote 
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Est. Pay Range:: $53.00/hour –$58.00/Hour on W2 (USD)

Schedule: Business Hours are 7am - 8pm EST Monday - Friday and 7am - 4: 30pm EST Sat and Sunday. Set Rotation.

Description:

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


Duties  
Case Review and Processing
•Process incoming coverage-related requests from members and prescribers.
•Accurately set up cases, review documentation, and apply work instructions to ensure correct and timely processing.
•Read, analyze, and interpret business and medical correspondence, technical procedures, and Medicare regulations to support decision-making.
 
Outreach and Information Gathering
•Conduct outbound calls to members and providers to obtain missing or additional information required to complete requests.
•Communicate clearly, professionally, and empathetically while projecting a positive business image.
 
Documentation, Accuracy, and Compliance Standards
•Provide clear, concise, and accurate documentation of all case activity across systems.
•Ensure all cases are properly closed and meet CMS-mandated timelines, department productivity expectations, and quality standards.
•Apply clinical judgment and knowledge effectively, utilizing drug compendia resources, evolving work instructions, and CMS Medicare guidance.
 
Continuous Learning and Development
•Acquire and maintain working knowledge of evolving work instructions, systems, and Medicare guidance.
•Participate in coaching, feedback, and development discussions with direct leadership.

Experience     
Previous experience in managed care, PBM environment, institutional healthcare, pharmacy, or related experience (preferred).

Position Summary     
As a Clinical Pharmacist Advisor, Medicare B Operations, you will support Medicare Part B members, prescribers, and providers by processing coverage-related requests for injectable and infused medications covered under their medical benefits. You will be responsible for accurate case set up, review of 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 guidelines, CMS-mandated timelines, and internal quality standards. You will demonstrate strong attention to detail, professional verbal and written communication skills, and the ability to problem-solve in a highly regulated, fast-paced environment. This is a great opportunity to initiate a career with a leading healthcare company by reviewing information and completing timely and accurate documentation of Medicare Part B requests, in compliance with Medicare guidelines, while promoting a best-in-class service experience.
This position is full-time, remote, non-exempt, and requires schedule flexibility based on business needs.

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


If you believe you're qualified for this position and are currently in the job market or interested in making a change, please give me a call as soon as possible at 571 678 0714.