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Clinical Pharmacist Advisor – Medicare Part D (REMOTE) Location: 100% Remote (U.S.) Pay Rate: $53.00/hr Schedule: Set rotation within business hours (see below) Opportunity: Contract with potential for full-time conversion About the Role We are hiring 50 Remote Clinical Pharmacist Advisors to support Medicare Part D members and providers in a fast-paced, high-volume, production-driven environment.

This role is ideal for pharmacists with prior authorization, managed care, or PBM experience who thrive in a structured, remote setting.

As a Clinical Pharmacist Advisor, you will review pharmacy benefit requests, make clinical determinations, and ensure compliance with CMS and Medicare guidelines while delivering best-in-class service.

Key Responsibilities Review and process prior authorizations, coverage determinations, and appeals Evaluate clinical documentation to support approval/denial decisions Ensure all cases meet Medicare Part D and CMS compliance standards Conduct provider outreach to obtain additional clinical information Document all decisions clearly and accurately in system workflows Manage high-volume queues while meeting productivity and quality metrics Apply clinical knowledge using drug compendia and established guidelines Required Qualifications Active Pharmacist license in state of residence (in good standing) PharmD or Bachelor’s Degree in Pharmacy Strong computer skills (Excel, Word required; Access, PowerPoint, Visio preferred) Experience with data entry, dual screens, and multiple systems Ability to work independently in a productivity-driven remote environment Strong attention to detail and documentation accuracy Preferred Experience Managed Care / PBM experience Prior Authorization, Coverage Determinations, or Appeals Medicare Part D knowledge and CMS guideline familiarity Remote pharmacist or high-volume review experience Retail + Managed Care hybrid background Schedule & Training Requirements Training: Monday–Friday, 9:00 AM – 5:30 PM EST (first 8 weeks – no time off allowed) Post-Training Schedule: Business Hours: 7:00 AM – 8:00 PM EST (Mon–Fri) Weekends: 7:00 AM – 4:30 PM EST Must be flexible to work assigned 8-hour shifts, including weekends Work Environment Requirements (MANDATORY) Dedicated, quiet, private workspace Wired internet connection: Minimum 25 Mbps download / 5 Mbps upload Speed test screenshot required (must be included on resume) Ability to remain on camera during training and team meetings Ability to sit and focus for full shift with minimal interruptions Submission Requirements (MUST BE INCLUDED ON RESUME) Screenshot of internet speed test ( ) Screenshot of active pharmacist license (showing name, state, expiration) Completed candidate questionnaire (see below) Candidate Pre-Screen Questionnaire (Include with Submission) Are you available for full-time training (M–F, 9–5:30 EST) for 8 weeks with no time off? Can you work any assigned 8-hour shift between 7 AM – 8 PM EST, including weekends? Do you have a dedicated, quiet workspace for remote work? Do you have wired internet meeting 25/5 Mbps requirements? Can you sit and focus for the entire shift without interruptions? Do you have experience with data entry and multiple systems/screens? Do you have an active pharmacist license in your state of residence? Are you comfortable working independently in a productivity-based role? Do you bring a positive, engaged attitude to a team environment? We are hiring 50 Remote Clinical Pharmacist Advisors to support Medicare Part D members and providers in a fast-paced, high-volume, production-driven environment.

This role is ideal for pharmacists with prior authorization, managed care, or PBM experience who thrive in a structured, remote setting.

As a Clinical Pharmacist Advisor, you will review pharmacy benefit requests, make clinical determinations, and ensure compliance with CMS and Medicare guidelines while delivering best-in-class service.

Key Responsibilities Review and process prior authorizations, coverage determinations, and appeals Evaluate clinical documentation to support approval/denial decisions Ensure all cases meet Medicare Part D and CMS compliance standards Conduct provider outreach to obtain additional clinical information Document all decisions clearly and accurately in system workflows Manage high-volume queues while meeting productivity and quality metrics Apply clinical knowledge using drug compendia and established guidelines
Remote working/work at home options are available for this role.

Why USAA?

At USAA, our mission is to empower our members to achieve financial security through highly competitive products, exceptional service and trusted advice. We seek to be the #1 choice for the military community and their families.

Embrace a fulfilling career at USAA, where our core values – honesty, integrity, loyalty and service – define how we treat each other and our members. Be part of what truly makes us special and impactful.

The Opportunity

As a dedicated Life Actuary Senior, you will lead advanced actuarial analyses and provide strategic insight into our reinsurance programs across Life and Annuity product portfolios.  This role combines deep technical expertise with strategic influence, supporting the optimization of reinsurance structures that manage risk, enhance capital efficiency, and drive long-term profitability.

This role is remote eligible in the continental U.S. with occasional business travel. However, individuals residing within a 60-mile radius of a USAA office will be expected to work on-site four days per week.

What you'll do:

• Perform complex and often unique work assignments utilizing actuarial modeling software driven models for pricing, valuation, and/or risk management.
• Review laws and regulations to ensure all processes are compliant and provides recommendations for improvements. Monitor industry communications regarding potential changes to existing laws and regulations.
• Share knowledge with team members and serves as a key resource to entire team, including leadership, on escalated issues and navigates obstacles to deliver work product.
• Serve as a Subject Matter Expert in one or more key areas, such as Product Pricing, Reserving, Economic Capital, Modeling, Asset Liability Management, etc.
• Lead a project team on complex assignments through concept, planning, execution, and implementation phases involving cross functional actuarial areas.
• Develop exhibits and reports that help explain proposals/findings and provides information in an understandable and usable format for stakeholders.
• Identify and provides recommended solutions to business problems independently, often presenting recommendation to leadership.
• Maintain proper price level, price structure, data availability and other requirements to achieve profitability and competitive goals.
• Identify critical assumptions to monitor and suggest timely remedies to correct or prevent unfavorable trends.
• Test impact of assumptions by identifying sources of gain and loss, the appropriate premiums, interest margins, reserves, and cash values for profitability and viability of new and existing products.
• Ensure risks associated with business activities are effectively identified, measured, monitored, and controlled in accordance with risk and compliance policies and procedures.

What you have:

• Bachelor’s degree; OR 4 years of related experience (in addition to the minimum years of experience required) may be substituted in lieu of degree.
• 6 years actuarial experience and attainment of Fellow within the Society of Actuaries; OR 12 years relevant actuarial experience and attainment of Associate within the Society of Actuaries.
• Subject Matter Expert in one or more key areas, such as Product Pricing, Reserving, Economic Capital, Modeling, Asset Liability Management, etc.
• Experience leading a project team on complex assignments through concept, planning, execution, and implementation phases involving cross functional actuarial areas.
• Demonstrated experience preparing effective documentation, facilitating training and development, and presenting to various levels of management.

What sets you apart:

• Detailed knowledge of various types of reinsurance transactions both onshore and offshore spanning both block and new business flow transactions
• Experience evaluating the financial, capital, and risk implications of various reinsurance structures, including quota share, YRT, and coinsurance arrangements.
• Experience designing and implementing models to assess the impact of reinsurance under multiple economic and regulatory scenarios
• Experience collaborating with Finance, Risk, Product Development, and Reinsurance Operations teams to integrate reinsurance insights into pricing, financial planning, and business strategy
• Experience with preparing and communicating analyses and recommendations to senior management and external partners, including reinsurers and consultants
• Experience supporting treaty negotiations and term assessment through data-driven modeling and sensitivity analysis
• US military experience through military service or a military spouse/domestic partner

Compensation range: The salary range for this position is: $143,320 - $265,950.

USAA does not provide visa sponsorship for this role. Please do not apply for this role if at any time (now or in the future) you will need immigration support (i.e., H-1B, TN, STEM OPT Training Plans, etc.).

Compensation: USAA has an effective process for assessing market data and establishing ranges to ensure we remain competitive. You are paid within the salary range based on your experience and market data of the position. The actual salary for this role may vary by location.

 

Employees may be eligible for pay incentives based on overall corporate and individual performance and at the discretion of the USAA Board of Directors.

The above description reflects the details considered necessary to describe the principal functions of the job and should not be construed as a detailed description of all the work requirements that may be performed in the job.

 

Benefits: At USAA our employees enjoy best-in-class benefits to support their physical, financial, and emotional wellness. These benefits include comprehensive medical, dental and vision plans, 401(k), pension, life insurance, parental benefits, adoption assistance, paid time off program with paid holidays plus 16 paid volunteer hours, and various wellness programs. Additionally, our career path planning and continuing education assists employees with their professional goals.

 

For more details on our outstanding benefits, visit our benefits page on .

Applications for this position are accepted on an ongoing basis, this posting will remain open until the position is filled. Thus, interested candidates are encouraged to apply the same day they view this posting.

 

USAA is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

Remote working/work at home options are available for this role.