REMOTE PHARMACIST

TPIS; San Juan (PR); Remote; USD 46,800 - 57,200; Full time

Job summary

TPIS is seeking a licensed Pharmacist to join our remote team supporting a health insurance client. You will manage provider calls and review clinical information to determine coverage, approving or denying requests per plan criteria.

Responsibilities include documenting rationale and ensuring compliance with state, federal, CMS, and accreditation requirements.

Qualifications

• Experience providing phone or chat support in healthcare or insurance settings.
• Strong computer skills including MS Windows applications and navigating complex systems.
• Bilingual fluency in English and Spanish is required.

Responsibilities

• Handle outbound calls to providers.
• Support Medicare and Retirement lines via phone and chat.
• Review clinical information to determine plan-specific coverage.
• Evaluate diagnosis, therapy history, and dosing for coverage decisions.
• Approve or deny requests based on criteria and regulations.
• Escalate to Medical Director when needed for review.
• Document rationale and ensure compliance with CMS and accreditation requirements.

Skills

Phone support

MS Windows

Bilingual English/Spanish

Licensed Pharmacist

Education

Pharmacist license

Job description

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

REMOTE PHARMACIST

San Juan, PR, PR

2 days ago Requisition ID: 2145

Salary: $52.00 Annually

We are looking for licensed Pharmacists to join one our our renowned clients in the Health Insurance Industry. If you have the credentials, and able to work remotely, this opportunity is for you!

Primary Responsibilities:

• Manage outbound calls to providers.
• Provide support for both Medicare and Retirement via phone and chat.
• Reviewing clinical information submitted by providers to determine whether a medication meets plan-specific coverage criteria.
• Evaluating factors such as diagnosis, previous therapies, treatment history, quantity requested, dosing, and clinical
• Approving requests when criteria are met.
• Issuing clinical denials when criteria are not met and plan regulations allow pharmacist-level decisioning.
• Referring cases to a Medical Director when regulatory or client requires physician review before a denial can be
• Documenting clinical rationale and ensuring all decisions comply with client, state, federal, CMS, and accreditation
• requirements.

Required Qualifications:

• 1+ years of experience in a related environment (i.e. office, administrative, clerical, customer service, etc.) using phones and computers as the primary job tools
• Advanced Microsoft and Windows PC applications skills, which includes the ability to navigate and learn new and complex computer system applications
• Available to work (40 hours/week) Monday- Friday. Flexible to work any of our 8 hour shift schedules during our normal business hours of (8:00am to 7:00pm ATL)
• Bilingual Spanish/English proficiency

We are looking for licensed Pharmacists to join one our our renowned clients in the Health Insurance Industry. If you have the credentials, and able to work remotely, this opportunity is for you!

Primary Responsibilities:

• Manage outbound calls to providers.
• Provide support for both Medicare and Retirement via phone and chat.
• Reviewing clinical information submitted by providers to determine whether a medication meets plan-specific coverage criteria.
• Evaluating factors such as diagnosis, previous therapies, treatment history, quantity requested, dosing, and clinical
• appropriateness.
• Approving requests when criteria are met.
• Issuing clinical denials when criteria are not met and plan regulations allow pharmacist-level decisioning.
• Referring cases to a Medical Director when regulatory or client requires physician review before a denial can be
• issued.
• Documenting clinical rationale and ensuring all decisions comply with client, state, federal, CMS, and accreditation
• requirements.

Required Qualifications:

• Valid Pharmacist license
• 1+ years of experience in a related environment (i.e. office, administrative, clerical, customer service, etc.) using phones and computers as the primary job tools
• Advanced Microsoft and Windows PC applications skills, which includes the ability to navigate and learn new and complex computer system applications
• Available to work (40 hours/week) Monday- Friday. Flexible to work any of our 8 hour shift schedules during our normal business hours of (8:00am to 7:00pm ATL)
• Bilingual Spanish/English proficiency

Monday to Friday
8:00am - 7:00pm rotating schedules