Duration: 11+ Months
Job Description:
- The Clinical Pharmacist Advisor – Medicare supports Medicare Part D members and healthcare providers by reviewing pharmacy benefit requests and ensuring timely, accurate, and compliant case processing.
- This role involves evaluating clinical information, documenting case decisions, conducting provider outreach when necessary, and ensuring compliance with Medicare guidelines and regulatory timelines.
- The ideal candidate will demonstrate strong clinical judgment, attention to detail, and the ability to work independently in a fast-paced, productivity-driven remote environment.
Responsibilities:
- Review Medicare Part D pharmacy benefit requests and ensure accurate case setup.
- Evaluate clinical information and supporting documentation to make appropriate coverage determinations.
- Contact healthcare providers to obtain additional clinical information when required.
- Document case findings and decisions clearly and accurately.
- Process cases in accordance with Medicare guidelines, departmental procedures, and regulatory requirements.
- Meet CMS-required turnaround times while maintaining productivity and quality standards.
- Utilize clinical judgment and drug information resources to support decision-making.
- Maintain compliance with evolving work instructions, Medicare guidance, and internal policies.
- Participate in coaching, development discussions, and continuous improvement activities.
- Deliver exceptional service to members and providers while maintaining accuracy and efficiency.
Experience:
- Experience in a Managed Care or Pharmacy Benefit Management (PBM) environment is preferred.
- Experience reviewing clinical information and making pharmacy benefit determinations is preferred.
- Strong knowledge of Medicare Part D guidelines and pharmacy benefit processes is preferred.
- Experience with data entry and working across multiple computer applications.
- Ability to work independently in a productivity-driven environment.
- Strong organizational, analytical, and documentation skills.
- Excellent verbal and written communication skills.
Skillsets:
- Medicare Part D
- Clinical Pharmacy
- Pharmacy Benefit Management (PBM)
- Managed Care
- Clinical Case Review
- Prior Authorization
- Appeals Review
- Clinical Documentation
- Drug Information Resources
- Clinical Decision Making
- Regulatory Compliance
- CMS Guidelines
- Data Entry
- Microsoft Excel
- Microsoft Word
- Microsoft Access (Preferred)
- Microsoft PowerPoint (Preferred)
- Microsoft Visio (Preferred)
- Multitasking
- Customer Service
- Time Management
- Written and Verbal Communication
Education:
- Bachelor’s degree in Pharmacy or Doctor of Pharmacy (PharmD).
Licenses:
- Active Registered 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, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.
AI Statement: By applying, you acknowledge that AI-assisted tools may be used during the hiring process.
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