Remote Clinical Pharmacist Advisor

Remote Clinical Pharmacist Advisor

HealthCare Support is actively seeking a Remote Clinical Pharmacist Advisor to fill an opening with one of the largest PBM Pharmacy in the US.

Daily Responsibilities for Remote Clinical Pharmacist Advisor:

• Will be directly supporting Medicare Part D members and providers with requests related to their pharmacy benefits
• Responsible for ensuring cases are accurately set up for our members, reviewing clinical information for decisioning the request, performing outreach to providers for more information when needed, and ensuring accurate decisions that comply with compendia and Medicare guidance and timelines
• The role involves ensuring the accuracy of case setup and clinical review of Medicare appeals cases by thoroughly reviewing internal notes or fax requests for pertinent information, providing clear and concise documentation, and contacting providers when necessary to obtain clinical details for case decisions. It requires adherence to work instructions and Medicare guidelines to ensure proper case processing
• The position also demands compliance with CMS-mandated timelines, as well as departmental productivity and quality standards. Clinical judgment and knowledge must be applied effectively, utilizing drug compendia resources, evolving work instructions, and CMS Medicare guidance.
• Additionally, the role includes participating in development discussions and receiving feedback from the direct supervisor to support continuous improvement
• Can accommodate training hours Monday to Friday 9:00 AM – 5:30 PM EST and shifts based on business needs and will include either 1 weekend day, or a weekend rotation. Business Hours are 7:00 AM – 8:00 PM EST Monday – Friday and 7:00 AM – 4:30 PM EST Saturday and Sunday

Required Qualifications for Remote Clinical Pharmacist Advisor:

• Active Pharmacist license in the state of residence 
• Previous experience in Managed Care/ PBM environment preferred
• Clinical experience: Medicare Part D/ or prior-authorization experience required (please add on resume how many cases they processed per day) 
• Bachelor’s degree in pharmacy or Pharm D. required
• Knowledge of MS Word, Excel required. Access, Power Point, and Visio are preferable

Benefits for Remote Clinical Pharmacist Advisor

• Immediate enrollment in Health Insurance
• Dental Insurance
• Life Insurance
• Employee Assistance Program (EAP)
• Access to Investment Accounts
• Career and educational tools within our Ingenovis ACT (Advocacy) Program

Pay Details: $53.00-$55.00/ hour

Interested in being considered?
If you are interested in applying to this position, please click Apply Now for immediate consideration.

For additional consideration, please email a copy of your resume to leslie.quijano@healthcaresupport.com with your phone number, the job title and location, and our recruiters will reach out.
Healthcare Support Staffing, LLC is an equal employment opportunity employer and will consider all qualified applicants without regard to race, color, religion, disability, sex, sexual orientation, gender identity, national origin, protected veteran status, or any other characteristic protected by applicable local, state, or federal law.