Pharmacist - Clinical Pharmacist Advisor Medicare

ICONMA; Myrtle Point (OR); Remote; USD 80,000 - 100,000; Full time

Job summary

A retail pharmacy company is seeking a Clinical Pharmacist Advisor for their remote location. This role involves ensuring the accuracy of Medicare appeals cases and requires a Bachelor's in pharmacy or Pharm D along with active state licensure. The position offers health benefits and opportunities for growth. Candidates with Managed Care or PBM experience are preferred.

Benefits

Health Benefits

Referral Program

Excellent growth and advancement opportunities

Qualifications

• Bachelor's degree in pharmacy or Pharm D required.
• Active license in good standing in state of residence.
• Previous experience in Managed Care/PBM environment preferred.

Responsibilities

• Ensure accuracy of case setup and clinical review of Medicare appeals cases.
• Adhere to work instructions and Medicare guidelines.
• Comply with CMS-mandated timelines and departmental standards.
• Apply clinical judgment and utilize drug compendia resources.

Job description

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

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.

Requirements:

• 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.