Clinical Pharmacist Advisor Medicare

ICONMA; Willow (AK); Remote; USD 80,000 - 100,000; Full time

Job summary

A leading retail pharmacy is seeking a Clinical Pharmacist Advisor Medicare for a remote position. You will support Medicare Part D members and providers with pharmacy benefits, ensuring compliance with guidelines. The role requires a licensed pharmacist with experience in Managed Care, excellent clinical judgment, and proficiency in tools like Excel and Word. Strong growth opportunities and health benefits are offered.

Benefits

Health Benefits

Referral Program

Excellent growth and advancement opportunities

Qualifications

• Licensed Registered Pharmacist in state of residence.
• Experience in Managed Care/PBM environment preferred.
• Adherence to work instructions and compliance with CMS-mandated timelines.

Responsibilities

• Support Medicare Part D members and providers with pharmacy benefit requests.
• Ensure accurate case setup and clinical review of Medicare appeals cases.
• Conduct outreach to providers for clinical information.
• Complete timely and accurate documentation of requests.

Skills

Knowledge of Medicare guidelines

Clinical judgment

Computer literacy

Customer service

Education

Bachelor's degree in pharmacy or Pharm D

High School Diploma or GED

Tools

Access

Power Point

Visio

Excel

Word

Job description

Overview

Our Client, a Retail Pharmacy company, is looking for a Clinical Pharmacist Advisor Medicare for their Remote location.

Responsibilities

• As an RPh & Clinical Pharmacist Advisor you 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, review 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.
• This is a great opportunity to initiate a career with a leading healthcare company by reviewing information and completing timely and accurate documentation of all Medicare Part D requests, in compliance with Medicare guidelines, while promoting a best-in-class service experience.
• 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.

Requirements

• It requires adherence to work instructions and Medicare guidelines to ensure proper case processing.
• Knowledge of Access, Power Point, and Visio is preferable.
• Must be computer literate – knowledge of Excel and Word.
• Licensed Registered Pharmacist in state of residence
• 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.
• Verifyable High School Diploma or GED Required
• Previous experience in Managed Care/PBM environment (preferred)
• Bachelor's degree in pharmacy or Pharm D. required. Must have an active license in good standing in state of residence.

Why Should You Apply?

• Health Benefits
• Referral Program
• Excellent growth and advancement opportunities

As an equal opportunity employer, ICONMA provides an employment environment that supports and encourages the abilities of all persons without regard to race, color, religion, gender, sexual orientation, gender identity or express, ethnicity, national origin, age, disability status, political affiliation, genetics, marital status, protected veteran status, or any other characteristic protected by federal, state, or local laws.