Clinical Pharmacist Advisor (Medicare Part D) – REMOTE

Clinical Pharmacist Advisor (Medicare Part D) – Remote | $53/hour We are seeking a highly experienced Clinical Pharmacist Advisor to support Medicare Part D operations in a fully remote environment. This role is ideal for pharmacists with a strong background in PBM (Pharmacy Benefit Management), Managed Care, Health Plan operations, and Prior Authorization determinations. This is a high-impact opportunity to work in a structured, performance-driven setting with the potential for long-term career growth. Schedule & Training Training: Monday – Friday, 9:00 AM – 5:30 PM EST (first 8 weeks, mandatory, no time off) Work Hours: Rotating shifts within: Monday – Friday: 7:00 AM – 8:00 PM EST Saturday & Sunday: 7:00 AM – 4:30 PM EST Must be flexible to work assigned shifts, including weekends Compensation Pay Rate: $53.00 per hour Opportunity for full-time conversion based on performance Work Environment & Requirements 100% Remote (Work From Home) Dedicated, quiet workspace required Wired internet connection required (minimum 25 Mbps download / 5 Mbps upload) Must provide internet speed test screenshot with application Must provide active pharmacist license screenshot (showing name, state, and validity dates) Job Overview In this role, you will review and process Medicare Part D requests, including prior authorizations and appeals, ensuring accurate clinical decision-making and strict compliance with CMS guidelines. You will collaborate with providers, analyze clinical data, and deliver timely, high-quality outcomes that directly impact patient care. Key Responsibilities Review and evaluate Medicare Part D prior authorization requests and appeals Accurately set up and document cases within internal systems Apply clinical judgment using drug compendia and CMS Medicare guidelines Conduct outreach to providers to obtain additional clinical information as needed Ensure compliance with CMS regulations, timelines, and internal quality standards Maintain clear, accurate, and detailed documentation Meet productivity and quality expectations in a fast-paced environment Participate in feedback and performance development discussions Required Qualifications (Must-Have) Active Pharmacist license in good standing in state of residence PharmD or Bachelor’s degree in Pharmacy REQUIRED: Prior experience in PBM, Managed Care, or Health Plan environment REQUIRED: Direct experience with Prior Authorization and/or coverage determination reviews Strong clinical decision-making and analytical skills Experience with data entry and navigating multiple systems simultaneously Ability to work independently in a remote, productivity-driven role Preferred Qualifications Medicare Part D experience Appeals and coverage determination experience Proficiency with Microsoft Excel, Word, Access, PowerPoint, and Visio Important Requirements: Camera must be on for training and team meetings Position is safety-sensitive Must be able to sit and remain focused for the duration of scheduled shifts Candidate Expectations Strong attendance is critical, especially during the first 8–10 weeks of training Ability to manage multiple systems and perform high-volume data entry Comfortable making outbound calls to providers when needed Positive, engaged, and team-oriented mindset Why Apply? This role offers experienced pharmacists the opportunity to leverage their managed care and prior authorization expertise in a remote setting while supporting Medicare members and providers. You will gain valuable experience in clinical review, compliance, and pharmacy benefit operations, with strong potential for long-term career advancement. #ALINE3