Remote Pharmacist

A-Line Staffing Solutions; Town of Texas (WI); Remote; USD 60,000 - 86,000; Full time

Benefits offered by this job

401(k) with company match

Benefits after 90 days

Job summary

A-Line Staffing is hiring a Pharmacist who will specialize in Medicare Part D - Clinical Review. This full-time, remote position offers 40+ hours per week with start date 11/09 and 8-10 weeks of training, Monday–Friday 9am-5:30pm EST, with potential overtime.

Responsibilities include supporting Medicare Part D members and providers, conducting clinical reviews in accordance with CMS guidelines, and documenting requests to meet CMS timelines.

Qualifications

• Licensed Pharmacist.
• Experience with PBMs, Utilization Management or Prior Authorization review preferred.

Responsibilities

• Support Medicare Part D members and providers with pharmacy benefit and coverage determination requests.
• Ensure accurate case setup and complete clinical review of Medicare appeals in compliance with CMS guidelines.
• Review clinical information and make appropriate determinations based on drug compendia and clinical judgment.
• Conduct provider outreach for additional clinical clarification when necessary.
• Accurately document all Medicare Part D requests and maintain compliance with CMS-mandated timelines.
• Meet or exceed departmental productivity and quality standards.

Skills

Pharmacist license

Medicare Part D knowledge

CMS guidelines

Utilization Management experience

Prior Authorization review

Tools

PBMs

Job description

A-Line Staffing is now hiring a Pharmacist -Medicare Part D- Clinical Review Specialist. This would be full time / 40+ hours per week. Pharmacist -Medicare Part D- Clinical Review Specialist Hours START DATE- 11/09 8-10 weeks of training - M-F - 9am-5:30pm EST (no vacation time planned). 40 hours per week, potential overtime Must be able to work ANY 8 hour shift from 7am - 8pm EST Monday – Friday 7am - 430pm EST Sat and Sunday. Rotating weekends FULLY REMOTE Pharmacist -Medicare Part D- Clinical Review Specialist Compensation The pay for this position is between $53.00 an hour Benefits are available to full-time employees after 90 days of employment A 401(k) with a company match is available for full-time employees with 1 year of service on our eligibility dates.

Responsibilities

• Support Medicare Part D members and providers with pharmacy benefit and coverage determination requests.
• Ensure accurate case setup and complete clinical review of Medicare appeals in compliance with CMS guidelines.
• Review clinical information and make appropriate determinations based on drug compendia and clinical judgment.
• Conduct provider outreach for additional clinical clarification when necessary.
• Accurately document all Medicare Part D requests and maintain compliance with CMS-mandated timelines.
• Meet or exceed departmental productivity and quality standards.

Requirements

• Licensed Pharmacist
• Experience with PBMS, Utilization Management or Prior Authorization review highly prefer #aline03