State Licensed Clinical Pharmacist

Job Summary

Supporting Medicare Part B members, the full-time Remote Medicare Clinical Pharmacist will process coverage-related requests for injectable and infused medications, review clinical information, and ensure compliance with CMS guidelines while working remotely.

Key responsibilities

• Process incoming coverage-related requests from members and prescribers, ensuring timely and accurate case establishment
• Review clinical documentation and apply Medicare regulations to support coverage decisions
• Conduct outreach to providers and members to gather additional information while maintaining professional communication

Required qualifications

• Bachelor's degree in Pharmacy or Doctor of Pharmacy (Pharm.D.)
• Active pharmacist license in good standing in the state of residence
• Two years of pharmacist experience in managed care or related healthcare
• Ability to accurately review clinical documentation and meet CMS-mandated timelines
• Knowledge of Medicare regulations and clinical documentation processes