Licensed Medicare Part D Pharmacist

Job Summary

Supporting Medicare Part D members and providers, the full-time Licensed Medicare Part D Pharmacist will manage pharmacy benefit requests and clinical reviews while working remotely with flexible hours.

Key responsibilities

• Support Medicare Part D members and providers with pharmacy benefit and coverage determination requests
• Ensure accurate case setup and complete clinical review of Medicare appeals in compliance with CMS guidelines
• Accurately document all Medicare Part D requests and maintain compliance with CMS-mandated timelines

Required qualifications

• Licensed Pharmacist
• Knowledge of Medicare Part D regulations, including coverage determinations and appeals (CMS guidelines)
• Experience with PBMS, Utilization Management, or Prior Authorization review highly preferred