Pharmacist – Clinical Pharmacist Advisor Medicare # 26-17629

US Tech Solutions•Please note: Actual location may vary., RI

1h•Remote

About The Position

The Clinical Pharmacist Advisor – Medicare supports Medicare Part D members and healthcare providers by reviewing pharmacy benefit requests and ensuring timely, accurate, and compliant case processing. This role involves evaluating clinical information, documenting case decisions, conducting provider outreach when necessary, and ensuring compliance with Medicare guidelines and regulatory timelines. The ideal candidate will demonstrate strong clinical judgment, attention to detail, and the ability to work independently in a fast-paced, productivity-driven remote environment.

Requirements

Experience with data entry and working across multiple computer applications.
Ability to work independently in a productivity-driven environment.
Strong organizational, analytical, and documentation skills.
Excellent verbal and written communication skills.
Active Registered Pharmacist license in good standing in the state of residence.

Nice To Haves

Experience in a Managed Care or Pharmacy Benefit Management (PBM) environment is preferred.
Experience reviewing clinical information and making pharmacy benefit determinations is preferred.
Strong knowledge of Medicare Part D guidelines and pharmacy benefit processes is preferred.
Microsoft Access (Preferred)
Microsoft PowerPoint (Preferred)
Microsoft Visio (Preferred)

Responsibilities

Review Medicare Part D pharmacy benefit requests and ensure accurate case setup.
Evaluate clinical information and supporting documentation to make appropriate coverage determinations.
Contact healthcare providers to obtain additional clinical information when required.
Document case findings and decisions clearly and accurately.
Process cases in accordance with Medicare guidelines, departmental procedures, and regulatory requirements.
Meet CMS-required turnaround times while maintaining productivity and quality standards.
Utilize clinical judgment and drug information resources to support decision-making.
Maintain compliance with evolving work instructions, Medicare guidance, and internal policies.
Participate in coaching, development discussions, and continuous improvement activities.
Deliver exceptional service to members and providers while maintaining accuracy and efficiency.