Clinical Pharmacist - Medicare / Prior Auth

Remote 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 Full-time

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

Remote Full-time

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

Remote Full-time

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

Remote Full-time

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

Remote Full-time

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

Remote Full-time

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

Remote Full-time

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

Remote Full-time

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

Remote Full-time

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

Remote Full-time

Entry Level Project Engineer Rotation Program – Construction Management, Civil Engineering, Mechanical Engineering, and Industrial Engineering Opportunities

Remote Full-time

Experienced Technical Support Specialist – Remote Chat Support Opportunity with blithequark – Earn $25-$35/hr

Remote Full-time

Game Artist / Game Designer (specializing in Instant Win Games)

Remote Full-time

Senior Product Designer

Remote Full-time

Remote Computer Science Tutor – GCSE & Level 3 Online Teaching Specialist for Secondary & Post‑16 Students (Flexible Hours, Competitive Pay)

Remote Full-time

AI Tech Developer/ Mission-Driven Problem Solver

Remote Full-time

Lead Business System Analyst

Remote Full-time

Experienced Virtual Chat Support Representative – Remote Work Opportunity with Flexible Scheduling and Competitive Hourly Rates

Remote Full-time

Experienced Marketing Coordinator for Original Content and Campaign Development - Hulu Originals Team

Remote Full-time

Retention Specialist - Remote - CA Only

Remote Full-time
← Back to Home