Remote Clinical Pharmacist Advisor- Medicare
Job Title: Remote Clinical Pharmacist Advisor – Medicare (Contract-to-Hire) Location: Remote (Must reside and be licensed in state of residence) Pay Rate: $53/hour Job Type: Contract-to-Hire Schedule: Business Hours are 7am - 8pm EST Monday - Friday and 7am - 430pm EST Sat and Sunday. Set Rotation Start Date : May 11th or 18th Position Overview We are seeking an experienced Clinical Pharmacist Advisor – Medicare to join a high-performing, remote clinical review team. This role focuses on prior authorizations, coverage determinations, and Medicare Part D reviews in a fast-paced, production-driven environment. This is an excellent opportunity for pharmacists with managed care, PBM, or Medicare experience who thrive in a remote, independent workflow setting and are comfortable handling high-volume clinical case reviews . Schedule
- Business Hours:
- Monday – Friday: 7:00 AM – 8:00 PM EST
- Saturday & Sunday: 7:00 AM – 4:30 PM EST
- Rotation: Set schedule (may include weekends)
- Training Schedule: Monday – Friday, 9:00 AM – 5:30 PM EST
Key Responsibilities
- Perform prior authorization and coverage determination reviews in accordance with clinical guidelines and CMS regulations
- Evaluate medication requests, including formulary exceptions, step therapy, and quantity limits
- Process appeals and denial reviews with accurate clinical documentation
- Apply Medicare Part D knowledge to ensure compliance and timely decision-making
- Communicate with providers to obtain necessary clinical information and explain determinations
- Document decisions clearly, including rationale for approvals or denials
- Maintain productivity and quality standards in a high-volume, queue-based environment
Required Qualifications
- Bachelor’s Degree in Pharmacy or PharmD
- Active Pharmacist License in good standing in state of residence
- Minimum 1+ year of experience in managed care, PBM, or prior authorization review
- Strong knowledge of Medicare Part D and pharmacy benefit structures
- Experience with:
- Prior authorizations
- Coverage determinations & appeals
- Clinical criteria and formulary reviews
Preferred Experience
- Previous experience in PBM environments (e.g., Medicare or commercial plans)
- Background in organizations such as CVS/Caremark, OptumRx, Cigna, Walgreens, or similar
- Combination of retail pharmacy + managed care experience
- Experience working in a remote, production-based role
Key Skills & Competencies
- Ability to manage high-volume case review queues with speed and accuracy
- Strong clinical decision-making and documentation skills
- Excellent provider communication and collaboration
- High level of attention to detail and compliance adherence
- Comfortable working independently in a remote environment with minimal supervision
- Strong computer proficiency and ability to navigate multiple systems simultaneously
What Makes a Strong Candidate Successful candidates typically bring:
- Proven experience in Medicare pharmacy benefit review work
- A track record of handling time-sensitive clinical decisions
- Comfort working in remote, metrics-driven environments
- Ability to clearly communicate clinical decisions and alternatives to providers
- Readiness to hit the ground running with minimal ramp-up time
Why Join Us?
- Fully remote opportunity
- Competitive hourly pay with contract-to-hire potential
- Structured training and support
- Opportunity to work with a leading clinical review team in the Medicare space INDJP
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Remote Skills: Clinical Information, Clinical Practices/Protocols, Clinical Study Publications, Clinical Validation, Communication Skills, Computer Skills, Consulting, Content Management Systems (CMS), Detail Oriented, Formulary, Maintain Compliance, Managed Care, Medicare, Medications, Metrics, Pharmacy, Production Systems, Quality Management, Quality Metrics, Regulations, Retail, Time Management About the Company: A-Line Staffing Solutions LLC A-Line Staffing Solutions is a premier staffing company that supplies professionals to the Healthcare, Insurance, Pharmaceutical, and Information Technology industries. Founded in 2004, A-Line Staffing Solutions has been a leader in matching talented individuals to the jobs that our clients NEED to fill. We are experts at offering creative staffing solutions to employers, and we are hiring every day. A-Line Staffing can offer short-term, long-term and direct-hire opportunities to professionals across the United States. We hire only the most qualified and talented individuals in the country. Our recruiting, selection and stringent screening processes have strengthened our reputation for delivering quality customer service and unbeatable talent. For our commissioned clients, A-Line Staffing closely follows the standards and practices established by The Joint Commission. For all of our clients and employees, our commitment to continual improvement combined with a strict code of ethics provides an atmosphere of respect and unparalleled professionalism. To find out how A-Line Staffing Solutions can share our talent with you, please contact us today. We are eager to include you among our most valued and satisfied clients. If you are a professional and would like to learn more about open opportunities in your area, please contact us today. We are always searching for talented and enthusiastic professionals Company Size: 1,000 to 1,499 employees Industry: Staffing/Employment Agencies Founded: 2004 Website: http://www.alinestaffing.com/ Apply tot his job Apply To this Job