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Posted 14 days ago
Requirements and responsibilities
Job Title: Clinical Pharmacist (Prior Authorization/PBM) -Fully Remote
Duration: 5 plus month with possible extension
Location: Fully Remote
Pay Range: $55- $58.00/hr
The role involves ensuring the accuracy of case setup and clinical review of Medicare appeals cases by thoroughly reviewing internal notes or fax requests for pertinent information, providing clear and concise documentation, and contacting providers when necessary to obtain clinical details for case decisions.
It requires adherence to work instructions and Medicare guidelines to ensure proper case processing. The position also demands compliance with CMS-mandated timelines, as well as departmental productivity and quality standards. Clinical judgment and knowledge must be applied effectively, utilizing drug compendia resources, evolving work instructions, and CMS Medicare guidance.
As a Clinical Pharmacist Advisor Medicare, 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 decisioning the request, performing outreach to providers for more information when needed, and ensuring accurate decisions that comply with compendia and Medicare guidance and timelines.
Optionally, you can add more information later (benefits, pre-screening questions, etc.)