Registered Clinical Pharmacist

Job Summary

To support Medicare members, the full-time Clinical Pharmacist Advisor will review pharmacy benefit requests, ensure accurate case setup, and evaluate clinical information while working remotely in the Northeast region.

Key responsibilities

• Review and process Medicare pharmacy benefit requests and appeals while ensuring compliance with CMS regulations
• Conduct outreach to providers and prescribers to gather additional clinical information for case reviews
• Maintain accurate documentation and meet productivity and quality standards in a remote work environment

Required qualifications

• Bachelor's Degree in Pharmacy or Doctor of Pharmacy (Pharm.D.) from an accredited institution
• Active Registered Pharmacist license in good standing in the state of residence
• Minimum 2 years of experience in managed care or related healthcare pharmacy environment
• Strong analytical skills with the ability to interpret Medicare guidelines and clinical documentation
• Proficiency in data entry and navigating multiple systems in a productivity-driven environment