Remote CMS Part D Pharmacist Reviewer (PRN)

Rainmakers Strategic Solutions, LLC.; United States; Remote; USD 83,000 - 124,000; Part time

Job summary

Rainmakers Strategic Solutions seeks PRN pharmacists to review sponsor-submitted prior authorization and step therapy criteria for CMS Part D. You will assess criteria against CMS guidance, FDA labeling, and standard references, determining approvability and writing precise comments for sponsors.

Role emphasizes accuracy, consistent reviews, and adherence to fixed CMS deadlines, with remote, US-based work and seasonal workload peaks from June to November.

Qualifications

• Doctor of Pharmacy degree from an accredited college or university.
• Current, active, unrestricted US license to practice pharmacy.
• Minimum five years in clinical pharmacy, formulary management, or Medicare Part D.
• Experience developing or reviewing PA and ST criteria for a Part D sponsor, PBM, or P&T committee preferred.
• Residency or board certification preferred.
• Advanced knowledge of Medicare Part D coverage and utilization management.
• Strong understanding of FDA-approved vs. compendia indications.
• Proven ability to review guidelines and evidence-based literature.
• Proficient with Micromedex, AHFS, NCCN, Clinical Pharmacology, Lexi-Drugs.
• Strong written communication for regulatory audiences.
• Ability to apply criteria consistently across large volumes under deadlines.
• Strong analytical, critical thinking, problem-solving skills.
• Ability to work independently with minimal supervision.
• Comfort with structured databases and MS Office tools.

Responsibilities

• Review PA and ST criteria for CMS Chapter 6 guidance in annual and monthly reviews.
• Evaluate each PA field for consistency with FDA labeling, compendia, and guidelines.
• Assess ST criteria for prereq drug appropriateness and on/off-label standards.
• Apply CMS principles for Part B vs Part D, step therapy, and formulary design.
• Support utilization management reviews for Inflation Reduction Act drugs.
• Write clear, specific comments to plan sponsors detailing issues.
• Review resubmitted criteria and formulary files for resolutions.
• Apply decisions across formularies using codes and precedents.
• Utilize drug information resources to support criteria evaluation.
• Interpret CMS Part D statutes and guidelines; stay updated on policy.

Skills

Medicare Part D knowledge

Utilization management

Clinical pharmacy

Regulatory writing

Regulatory review

Education

Doctor of Pharmacy (PharmD)

Active pharmacist license (US)

Residency or board certification preferred

Tools

Micromedex DrugDex

AHFS Drug Information

NCCN Guidelines

Clinical Pharmacology

Lexi-Drugs

Microsoft Access / SQL

Job description

Rainmakers Strategic Solutions seeks PRN pharmacists to review sponsor-submitted prior authorization and step therapy criteria for CMS Part D. You will assess criteria against CMS guidance, FDA labeling, and standard references, determining approvability and writing precise comments for sponsors.

Role emphasizes accuracy, consistent reviews, and adherence to fixed CMS deadlines, with remote, US-based work and seasonal workload peaks from June to November.