Engineering Structures Login Jobs in Pandora Ohio Remote
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Remote Clinical Pharmacist Advisor- Medicare
✦ New
Salary not disclosed
Job Title: Remote Clinical Pharmacist Advisor – Medicare (Contract-to-Hire) Location: Remote (Must reside and be licensed in state of residence) Pay Rate: $53/hour Job Type: Contract-to-Hire Schedule: Business Hours are 7am
- 8pm EST Monday
- Friday and 7am
- 430pm EST Sat and Sunday.
Set Rotation Start Date : May 11th or 18th Position Overview We are seeking an experienced Clinical Pharmacist Advisor – Medicare to join a high-performing, remote clinical review team.
This role focuses on prior authorizations, coverage determinations, and Medicare Part D reviews in a fast-paced, production-driven environment.
This is an excellent opportunity for pharmacists with managed care, PBM, or Medicare experience who thrive in a remote, independent workflow setting and are comfortable handling high-volume clinical case reviews .
Schedule Business Hours: Monday – Friday: 7:00 AM – 8:00 PM EST Saturday & Sunday: 7:00 AM – 4:30 PM EST Rotation: Set schedule (may include weekends) Training Schedule: Monday – Friday, 9:00 AM – 5:30 PM EST Key Responsibilities Perform prior authorization and coverage determination reviews in accordance with clinical guidelines and CMS regulations Evaluate medication requests, including formulary exceptions, step therapy, and quantity limits Process appeals and denial reviews with accurate clinical documentation Apply Medicare Part D knowledge to ensure compliance and timely decision-making Communicate with providers to obtain necessary clinical information and explain determinations Document decisions clearly, including rationale for approvals or denials Maintain productivity and quality standards in a high-volume, queue-based environment Required Qualifications Bachelor’s Degree in Pharmacy or PharmD Active Pharmacist License in good standing in state of residence Minimum 1+ year of experience in managed care, PBM, or prior authorization review Strong knowledge of Medicare Part D and pharmacy benefit structures Experience with: Prior authorizations Coverage determinations & appeals Clinical criteria and formulary reviews Preferred Experience Previous experience in PBM environments (e.g., Medicare or commercial plans) Background in organizations such as CVS/Caremark, OptumRx, Cigna, Walgreens, or similar Combination of retail pharmacy + managed care experience Experience working in a remote, production-based role Key Skills & Competencies Ability to manage high-volume case review queues with speed and accuracy Strong clinical decision-making and documentation skills Excellent provider communication and collaboration High level of attention to detail and compliance adherence Comfortable working independently in a remote environment with minimal supervision Strong computer proficiency and ability to navigate multiple systems simultaneously What Makes a Strong Candidate Successful candidates typically bring: Proven experience in Medicare pharmacy benefit review work A track record of handling time-sensitive clinical decisions Comfort working in remote, metrics-driven environments Ability to clearly communicate clinical decisions and alternatives to providers Readiness to hit the ground running with minimal ramp-up time Why Join Us? Fully remote opportunity Competitive hourly pay with contract-to-hire potential Structured training and support Opportunity to work with a leading clinical review team in the Medicare space INDJP .
Remote working/work at home options are available for this role.
- 8pm EST Monday
- Friday and 7am
- 430pm EST Sat and Sunday.
Set Rotation Start Date : May 11th or 18th Position Overview We are seeking an experienced Clinical Pharmacist Advisor – Medicare to join a high-performing, remote clinical review team.
This role focuses on prior authorizations, coverage determinations, and Medicare Part D reviews in a fast-paced, production-driven environment.
This is an excellent opportunity for pharmacists with managed care, PBM, or Medicare experience who thrive in a remote, independent workflow setting and are comfortable handling high-volume clinical case reviews .
Schedule Business Hours: Monday – Friday: 7:00 AM – 8:00 PM EST Saturday & Sunday: 7:00 AM – 4:30 PM EST Rotation: Set schedule (may include weekends) Training Schedule: Monday – Friday, 9:00 AM – 5:30 PM EST Key Responsibilities Perform prior authorization and coverage determination reviews in accordance with clinical guidelines and CMS regulations Evaluate medication requests, including formulary exceptions, step therapy, and quantity limits Process appeals and denial reviews with accurate clinical documentation Apply Medicare Part D knowledge to ensure compliance and timely decision-making Communicate with providers to obtain necessary clinical information and explain determinations Document decisions clearly, including rationale for approvals or denials Maintain productivity and quality standards in a high-volume, queue-based environment Required Qualifications Bachelor’s Degree in Pharmacy or PharmD Active Pharmacist License in good standing in state of residence Minimum 1+ year of experience in managed care, PBM, or prior authorization review Strong knowledge of Medicare Part D and pharmacy benefit structures Experience with: Prior authorizations Coverage determinations & appeals Clinical criteria and formulary reviews Preferred Experience Previous experience in PBM environments (e.g., Medicare or commercial plans) Background in organizations such as CVS/Caremark, OptumRx, Cigna, Walgreens, or similar Combination of retail pharmacy + managed care experience Experience working in a remote, production-based role Key Skills & Competencies Ability to manage high-volume case review queues with speed and accuracy Strong clinical decision-making and documentation skills Excellent provider communication and collaboration High level of attention to detail and compliance adherence Comfortable working independently in a remote environment with minimal supervision Strong computer proficiency and ability to navigate multiple systems simultaneously What Makes a Strong Candidate Successful candidates typically bring: Proven experience in Medicare pharmacy benefit review work A track record of handling time-sensitive clinical decisions Comfort working in remote, metrics-driven environments Ability to clearly communicate clinical decisions and alternatives to providers Readiness to hit the ground running with minimal ramp-up time Why Join Us? Fully remote opportunity Competitive hourly pay with contract-to-hire potential Structured training and support Opportunity to work with a leading clinical review team in the Medicare space INDJP .
Remote working/work at home options are available for this role.
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