Remote Pharmacist: Medicare Part D Criteria Reviewer

Rainmakers Strategic Solutions, LLC.; Oregon; Hybrid; USD 83,000 - 124,000; Part time

Job summary

Rainmakers Strategic Solutions seeks PRN pharmacists to support CMS PA and ST criteria reviews for Medicare Part D plan sponsors. Reviewers assess sponsor criteria against CMS guidance, FDA labeling, and standard guidelines, delivering precise comments within fixed CMS deadlines.

Requires strong Part D knowledge, clinical judgment, and ability to work independently using structured data tools; remote, seasonal workload with peak June–November.

Qualifications

• Pharmacist with a US PharmD from an accredited school.
• Current, active, unrestricted license to practice pharmacy in the United States.
• Minimum five years of experience in clinical pharmacy or related fields.
• Experience developing or reviewing PA and ST criteria for Part D sponsors preferred.
• Pharmacy residency or board certification preferred.
• Advanced knowledge of Medicare Part D coverage and utilization management.
• Strong understanding of FDA-approved vs. compendia-supported indications.
• Ability to apply treatment guidelines and evidence-based literature.
• Proficiency with Micromedex, AHFS, NCCN, Clinical Pharmacology, Lexi-Drugs.
• Strong written communication for regulatory audience.
• Ability to apply review criteria consistently across large volumes.

Responsibilities

• Review PA and ST criteria for CMS Chapter 6 guidance compliance.
• Evaluate each criteria field for FDA labeling alignment and guidance.
• Assess ST criteria for clinical appropriateness and burden.
• Apply CMS pass/fail decisions and precedents.
• Support reviews of formulary files and clinical justifications.
• Write clear, targeted comments for sponsors.
• Review resubmitted criteria and formulary files for fixes.
• Ensure consistency across formularies using codes.
• Apply CMS Part D statutes and guidance.
• Maintain knowledge of CMS Part D policy and new drug approvals.

Skills

Clinical pharmacy

Formulary management

Medicare Part D

Regulatory writing

Data analysis

MS Office

Communication skills

Independent work

Education

Doctor of Pharmacy degree

Pharmacy residency or board certification

Tools

Micromedex DrugDex

AHFS Drug Information

NCCN Guidelines

Clinical Pharmacology

Lexi-Drugs

Job description

Rainmakers Strategic Solutions seeks PRN pharmacists to support CMS PA and ST criteria reviews for Medicare Part D plan sponsors. Reviewers assess sponsor criteria against CMS guidance, FDA labeling, and standard guidelines, delivering precise comments within fixed CMS deadlines.

Requires strong Part D knowledge, clinical judgment, and ability to work independently using structured data tools; remote, seasonal workload with peak June–November.