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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 OCTOBER 12th
• 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

Pharmacist -Medicare Part D- Clinical Review Specialist 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.

Pharmacist -Medicare Part D- Clinical Review Specialist Requirements

• Licensed Pharmacist
• Knowledge of Medicare Part D regulations, including coverage determinations and appeals (CMS guidelines)
• Experience with PBMS, Utilization Management or Prior Authorization review highly preferred

If you think this Pharmacist -Medicare Part D- Clinical Review Specialist Position is a good fit for you, please reach out to me - feel free to call, e-mail, or apply to this posting!