Pharmacist # 26-22597

US Tech Solutions; Rhode Island; On-site; USD 110,000 - 140,000; Full time

Job summary

US Tech Solutions is seeking a Clinical Pharmacist Advisor Medicare to support Medicare Part D members and providers with pharmacy benefits requests. You will set up cases, review clinical information for decisioning, and reach out to providers to obtain needed details, ensuring decisions comply with compendia and Medicare guidance.

This 12-month contract offers a hands-on role in a leading healthcare company, focusing on accurate documentation and timely processing of Part D requests while

Qualifications

• Pharmacist licensed in good standing in the state of residence.
• Bachelor's degree in pharmacy or PharmD required.
• Experience in Managed Care/PBM preferred.

Responsibilities

• Review Medicare Part D requests and ensure accurate case setup.
• Perform clinical information review and provide decision support.
• Coordinate with providers for additional information and ensure CMS timelines are met.
• Document all actions clearly to support compliant decisions.

Skills

Pharmacist

Prior Authorization

PA Request

Medicare Part D

Pharmacy Benefit management

PBM

Managed care

Education

Bachelor's degree in pharmacy or Pharm D.

Job description

• As a Clinical Pharmacist Advisor Medicare, you will be directly supporting Medicare Part D members and providers with requests related to their pharmacy benefits.
• You will be 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.

Duration: 12 months contract

Job Description:

• As a Clinical Pharmacist Advisor Medicare, you will be directly supporting Medicare Part D members and providers with requests related to their pharmacy benefits.
• You will be 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.

Responsibilities:

• 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

Skills:

• Pharmacist
• Prior Authorization
• PA Request
• Medicare Part D
• Pharmacy Benefit management
• PBM
• Managed care

Experience:

• Previous experience in Managed Care/PBM environment (preferred).

Education:

• Bachelor's degree in pharmacy or Pharm D. required.
• Must have an active license in good standing in 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:

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