Clinical Pharmacist - Medicare / Prior Auth

Remote, USA Full-time
Job Title: Clinical Pharmacist - Medicare / Prior Auth Location: 100% Remote Contract: 6 month+ (Possibilities of Extension) Shift: 7 AM–8 PM EST (rotational schedule) Pay Range: $50 - $55/hr. on W2 Position Overview: We’re seeking a detail-oriented and clinically driven Clinical Pharmacist Advisor to support Medicare and Prior Authorization operations. In this role, you’ll review, analyze, and process pharmacy benefit requests while ensuring compliance with regulatory and clinical standards. This position requires precision, professionalism, and a commitment to improving patient outcomes—all from the comfort of your home. Key Responsibilities: • Review and process Medicare Part D pharmacy benefit requests efficiently and accurately. • Evaluate clinical information and apply sound clinical judgment based on established criteria and guidelines. • Interpret internal notes, documentation, and fax requests to confirm complete and compliant case setup. • Conduct outreach to providers, members, and pharmacies as needed to obtain additional clinical data. • Make evidence-based determinations using Medicare compendia and formulary policies. • Ensure all work aligns with HIPAA regulations, CMS guidelines, and organizational standards. Job Title: Clinical Pharmacist - Medicare / Prior Auth Location: 100% Remote Contract: 6 month+ (Possibilities of Extension) Shift: 7 AM–8 PM EST (rotational schedule) Pay Range: $50 - $55/hr. on W2 Position Overview: We’re seeking a detail-oriented and clinically driven Clinical Pharmacist Advisor to support Medicare and Prior Authorization operations. In this role, you’ll review, analyze, and process pharmacy benefit requests while ensuring compliance with regulatory and clinical standards. This position requires precision, professionalism, and a commitment to improving patient outcomes—all from the comfort of your home. Key Responsibilities: • Review and process Medicare Part D pharmacy benefit requests efficiently and accurately. • Evaluate clinical information and apply sound clinical judgment based on established criteria and guidelines. • Interpret internal notes, documentation, and fax requests to confirm complete and compliant case setup. • Conduct outreach to providers, members, and pharmacies as needed to obtain additional clinical data. • Make evidence-based determinations using Medicare compendia and formulary policies. • Ensure all work aligns with HIPAA regulations, CMS guidelines, and organizational standards. Apply tot his job
Apply Now

Similar Jobs

Experienced Remote Data Entry Clerk and Typing Specialist for Full-Time or Part-Time Opportunities with Unlimited Growth Potential at blithequark

Remote, USA Full-time

Experienced Customer Service Representative – Remote Part-Time Live Chat Support Specialist for E-commerce Platform

Remote, USA Full-time

Experienced Remote Chat Support Agent – Public Relations and Customer Service Expertise for blithequark

Remote, USA Full-time

Pharmacy Specialist, Pain Management (Pharmacist 5) – Pharmacy Inpatient in Sacramento, CA

Remote, USA Full-time

Experienced Remote Administrative Assistant – Full/Part Time Data Entry and Customer Service Representative for Blithequark

Remote, USA Full-time

Experienced Remote Data Entry Specialist – Full-Time Opportunity for Detail-Oriented Professionals to Join blithequark's Dynamic Team

Remote, USA Full-time

Experienced Remote Customer Support Specialist – Technical Troubleshooting and Customer Service Expert for blithequark

Remote, USA Full-time

Experienced Remote Customer Support Agent – Delivering Unparalleled Travel Experiences and Exceptional Client Service

Remote, USA Full-time

Experienced Technical Customer Support Specialist for Hospitality SaaS and Smart Home Devices – Remote Troubleshooting and Installation Support

Remote, USA Full-time

Experienced Part-Time Data Entry Clerk for Remote Work Opportunities in Market Research and Administration

Remote, USA Full-time

Medical Transcriptionist - PRN - Texas

Remote, USA Full-time

Apple Home Advisor (Multiple Locations) - OldCL US

Remote, USA Full-time

Sales Development Representative (US-based candidates only)

Remote, USA Full-time

Experienced Remote Data Entry Specialist – Accurate Information Management and Database Administration

Remote, USA Full-time

**Experienced Full Stack Customer Service Agent – Remote Customer Support for blithequark Airlines**

Remote, USA Full-time

[Remote] Virtual Data Entry Operator - Remote Opportunity

Remote, USA Full-time

Experienced Customer Support Specialist for Live Chat Services – Remote Work Opportunity with Flexible Hours and Competitive Pay

Remote, USA Full-time

Remote Administrative Assistant Opportunity with Starbucks - Work from Home, Competitive Salary, and Comprehensive Benefits

Remote, USA Full-time

Amazon Chat Support - Work At Home (Part Time Remote Job) – USA Remote Jobs

Remote, USA Full-time

Virtual Assistant (remote-work)

Remote, USA Full-time
Back to Home