Licensed Clinical Pharmacist Reviewer

Job Summary

To support the contract through independent clinical review, the part-time Licensed Clinical Pharmacist Reviewer will evaluate Medicare Part D reconsideration appeals, assess coverage eligibility, and ensure compliance with regulations in a remote environment.

Key responsibilities

• Perform independent clinical and policy reviews of Medicare Part D reconsideration appeals
• Analyze clinical documentation and pharmacy claims to determine coverage eligibility and payment appropriateness
• Draft clear clinical recommendations and maintain accurate documentation of review findings

Required qualifications

• Doctor of Pharmacy (PharmD) or Bachelor of Science in Pharmacy required
• Active, unrestricted pharmacist license in good standing
• Five or more years of experience in Medicare Part D operations or related fields
• Strong knowledge of Medicare Part D regulations and appeals processes
• Experience in clinical assessment and analytical skills