Licensed Pharmacist - Medicare Part D

Job Summary

A company is looking for a Pharmacist - Medicare Part D - Clinical Review Specialist.

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
• Review clinical information and make appropriate determinations based on drug compendia and clinical judgment

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