Licensed Pharmacist Reviewer

Job Summary

To support the Centers for Medicare & Medicaid Services (CMS), the PRN Pharmacist Reviewer will evaluate prior authorization and step therapy criteria for Medicare Part D plan sponsors, ensuring compliance with CMS guidelines, in a fully remote, seasonal role requiring approximately 20 hours per week during peak periods.

Key responsibilities:

• Reviews sponsor-submitted prior authorization and step therapy criteria for compliance with CMS guidance
• Evaluates clinical appropriateness of criteria fields and ensures consistency with FDA-approved labeling and treatment guidelines
• Writes clear and specific comments for plan sponsors on any deficiencies identified in the submitted criteria

Required qualifications:

• Doctor of Pharmacy degree from an accredited college or university
• Current, active, unrestricted license to practice pharmacy in the United States
• Minimum five years of experience in clinical pharmacy, formulary management, or Medicare Part D
• Experience developing or reviewing prior authorization and step therapy criteria for Part D plan sponsors preferred
• Advanced knowledge of Medicare Part D coverage requirements and utilization management programs