Remote Pharmacist Advisor (PBM Experience) REMOTE Prior Authorization

Detriot, MI

Posted: 06/13/2024 Category: Pharmacy Job Number: KS120300

Job Description

Remote Pharmacist (PBM Experience) REMOTE Prior Authorization

As an RPh Advisor you will be directly supporting Medicare Part D members and providers with requests related to their pharmacy benefits. You will be responsible for ensuring cases are accurately set up for our members, review clinical information for  the request, performing outreach to providers for more information when needed, and ensuring accurate decisions that comply with Medicare guidance. This is a great opportunity to initiate a career with a leading healthcare company by reviewing information and completing timely and accurate documentation of all Medicare Part D requests, in compliance with Medicare guidelines, while promoting a best-in-class service experience.

Please Contact: Katherine 586-710-0022 (call or text after you send your resume or apply to the job posting)

Pharmacist Schedule: 

  • Training M-F from 9am - 530pm EST for the first 8 weeks (no vacation time planned)
  • After training, our hours of operation are an 8 hours shift between 8AM - 8PM EST/CST M-F with rotating weekend schedules 7AM - 330PM EST/CST

Pharmacist Experience Requirements:

  • Previous pharmacy experience in PBM (pharmacy benefit management) or experience adjudicating prior authorization for a PBM
  • Pharm D, Pharmacist, RPH state license in the state that you will be working required, license should be in good standing.
  • Bachelor's degree in pharmacy or Pharm D.
  • At least two years of experience as a pharmacist
  • Basic computer skills required.
  • Strong organizational skill, interpersonal skills and detail orientation important for this position.

Technical Requirements:

  • Must have a smart phone, VPN will be added to the smartphone.
  • Must have a private area in home to work.

Internet Speed:

  • Minimal home broadband connectivity speed of 25 Mb downloads and 3 MB upload speed.
  • Speed for home internet can be confirmed by going to 


  • Collaborates with multiple groups within CD&A, including answering clinical questions, collecting appropriate clinical/ medical data needed to perform clinical assessments, and reviews as per the health plan/employer agreed criteria within the designated service level agreements. (20%)

  • Coordinates timely communication of case decision to physician, health-plan/employer, patient and other healthcare professionals following agreed upon approval & denial management processes. (20%)

  • Reviews cases in progress and provides a Clinical decision regarding Prior Authorizations, Tier Exceptions and Non-Formulary requests (50%)

  • Performs other related projects and duties as assigned including on call and after hours pharmacist availability could be required. (10%)

    Knowledge of Access, Power Point, and Visio is preferable.
    Must be computer literate – knowledge of Excel and Word.
    Licensed Registered Pharmacist in state of residence


Please Contact:

Katherine Skelton



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