Remote Pharmacist Reviewer: CMS Part D PA/ST Criteria

Rainmakers Strategic Solutions LLC; United States; Remote; USD 83,000 - 131,000; Full time

Benefits offered by this job

Health insurance

Job summary

Rainmakers Strategic Solutions LLC is seeking PRN pharmacists to support CMS contract reviewing prior authorization and step therapy criteria for Medicare Part D plan sponsors. Reviewers compare sponsor criteria to CMS Chapter 6 guidance, FDA labeling, and recognized guidelines to determine approvability.

This role is remote, not patient-facing, with peak workload during CMS annual review (June–November). Candidates should have a PharmD, active US license, and at least five years in clinical

Qualifications

• Doctor of Pharmacy degree from an accredited college or university.
• Current, active, unrestricted license to practice pharmacy in the United States.
• Minimum five years of experience in clinical pharmacy, formulary management, utilization management, or Medicare Part D.
• Experience developing or reviewing PA and ST criteria for a Part D plan sponsor, PBM, or P&T committee preferred.
• Pharmacy residency or board certification preferred.
• Advanced knowledge of Medicare Part D coverage requirements and utilization management programs.
• Strong understanding of FDA-approved versus medically accepted indications and coverage criteria.
• Strong clinical background with evidence-based literature review skills.
• Proficiency with Micromedex DrugDex, AHFS, NCCN guidelines, Clinical Pharmacology, Lexi-Drugs, and other drug information resources.
• Strong written communication for regulatory audiences and ability to review criteria consistently under deadlines.
• Ability to work independently with minimal supervision and handle data-driven review tools.
• Proficiency in Microsoft Office (Teams, Word, Excel, Outlook, SharePoint).

Responsibilities

• Reviews sponsor-submitted PA and ST criteria for CMS Chapter 6 compliance during annual and monthly reviews.
• Evaluates each PA criteria field for consistency with FDA labeling and recognized sources.
• Assesses ST criteria for clinical appropriateness and avoidance of undue burden.
• Applies CMS principles for Part B vs Part D and formulary design alignment.
• Writes clear, specific comments to sponsors for each issue identified.
• Reviews resubmitted criteria and formulary files to ensure issues are resolved.
• Applies decisions consistently across formularies using established precedents.
• Uses drug information resources to support clinical basis of criteria.

Skills

Clinical pharmacy

Regulatory writing

CMS Part D knowledge

Data-driven review

Education

Doctor of Pharmacy (PharmD)

Tools

Micromedex DrugDex

AHFS Drug Information

NCCN Guidelines

Lexi-Drugs

Microsoft Access/SQL

Job description

Rainmakers Strategic Solutions LLC is seeking PRN pharmacists to support CMS contract reviewing prior authorization and step therapy criteria for Medicare Part D plan sponsors. Reviewers compare sponsor criteria to CMS Chapter 6 guidance, FDA labeling, and recognized guidelines to determine approvability.

This role is remote, not patient-facing, with peak workload during CMS annual review (June–November). Candidates should have a PharmD, active US license, and at least five years in clinical