Job description

Clinical Pharmacist Advisor Medicare

Location: Remote
Duration: 12 Months

Description:
Position Summary:
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 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.
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.

Data entry and navigating multiple computer applications while utilizing two screens is the primary function of job (possible outbound calls needed).
A job history demonstrating this is recommended.
Do you have data entry experience

Verifiable High School Diploma or GED Required: Yes

Responsibilities:
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

Experience:
Minimum 1 year of experience although 2-5 years is preferred
License Pharmacist

Education:
Bachelor's Degree Required, Pharm D Preferred

Required profile