'Prior Authorization Pharmacist' - Fully Remote (Work from Home)

Prior Authorization Pharmacist – Fully Remote (Work from Home) Estimated Length of Assignment: 06+ Months with Possible Extension Dates: 12/08/2025 to 06/06/2026 (estimated) Pay Range: $53.00 – $56.00 per Hour (W2, all inclusive) Work Type: Fully Remote (Work from Home) Schedule: Shift: Business Hours 7am – 8pm EST Monday–Friday and 7am – 4:30pm EST Saturday & Sunday. Set Rotation. Required Technical Skills: • Knowledge of Access, PowerPoint, and Visio (preferred) • Computer literate with Excel and Word • Ability to work independently in a data entry, productivity-driven role Key Responsibilities: • Ensure accuracy of case setup and clinical review of Medicare appeals cases by thoroughly reviewing internal notes or fax requests for pertinent information, providing clear and concise documentation, and contacting providers when necessary to obtain clinical details for case decisions. • Adhere to work instructions and Medicare guidelines to ensure proper case processing. • Maintain compliance with CMS‑mandated timelines, departmental productivity, and quality standards. • Apply clinical judgment and knowledge using drug compendia resources, evolving work instructions, and CMS Medicare guidance. • Participate in development discussions and receive feedback from the direct supervisor to support continuous improvement. Position Summary: • As a Clinical Pharmacist Advisor Medicare you will directly support 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, reviewing 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 career opportunity with a leading healthcare company to review information and complete timely and accurate documentation of all Medicare Part D requests, in compliance with Medicare guidelines, while promoting a best‑in‑class service experience. Qualifications: • Licensed Registered Pharmacist in state of residence in good standing. • Active pharmacy license in good standing in state of residence (include screenshot on resume). • Experience in Managed Care/ PBM environment (preferred). • Previous experience in similar clinical pharmacist role (preferred). • Basic computer skills and proficiency with data entry. • Must have wired internet meeting 25 Mbps min download and 5 Mbps upload speed (include screenshot on resume). • Must be able to sit and focus on work for the duration of shift. • Must have dedicated quiet, separate space to work from home. Education: Bachelor’s degree in pharmacy or PharmD required. Benefits: • Medical, Dental, and Vision insurance options • 401(k) contributions • Critical Illness insurance • Voluntary permanent life insurance • Other employee perks How to Apply: If you are qualified, please call (571) 678-0609 to speak with a recruiter. All new hires required to appear on camera during meetings and training. Apply tot his job Apply To this Job