Pharmacist – Clinical Pharmacist Advisor Medicare # 26-17528

Duration 12 months

Position Summary:

As a Clinical Pharmacist Advisor – Medicare B Operations, you will support Medicare Part B members, prescribers, and providers by processing coverage-related requests for injectable and infused medications covered under their medical benefits. Responsibilities include reviewing clinical information, making accurate coverage decisions, conducting provider outreach when additional information is needed, and ensuring compliance with drug compendia, Medicare guidelines, CMS-mandated timelines, and internal quality standards.

This role requires strong attention to detail, professional verbal and written communication skills, and the ability to problem-solve in a highly regulated, fast-paced environment. This is a great opportunity to build a career with a leading healthcare company while reviewing and processing Medicare Part B requests and delivering a best-in-class service experience.

Key Responsibilities:

Case Review and Processing

• Process incoming coverage-related requests from members and prescribers.
• Accurately set up cases, review documentation, and follow work instructions to ensure timely and accurate processing.
• Read, analyze, and interpret business and medical correspondence, technical procedures, and Medicare regulations to support decision-making.

Outreach and Information Gathering

• Conduct outbound calls to members and providers to obtain missing or additional information required to complete requests.
• Communicate clearly, professionally, and empathetically while maintaining a positive business image.

Documentation, Accuracy, and Compliance

• Provide clear, concise, and accurate documentation of all case activity across systems.
• Ensure cases are properly closed and meet CMS-mandated timelines, productivity expectations, and quality standards.
• Apply clinical judgment and knowledge while utilizing drug compendia resources, evolving work instructions, and CMS Medicare guidance.

Continuous Learning and Development

• Acquire and maintain working knowledge of evolving work instructions, systems, and Medicare guidance.
• Participate in coaching, feedback, and professional development discussions with leadership.

Required Education

• Bachelor’s degree in pharmacy or Pharm.D. required.
• Must hold an active pharmacist license in good standing in the state of residence.

About US Tech Solutions:

US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit www.ustechsolutions.com .

US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, colour, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

AI Statement: By applying, you acknowledge that AI-assisted tools may be used during hiring.

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