Job Description
National leading healthcare company is hiring pharmacists for a remote 48 week role.
Clinical Pharmacist Advisor - Medicare
Work Location: Fully Remote (No onsite requirements)
Schedule:
**Training: Monday-Friday, 9:00 AM - 5:30 PM EST
**After training: Business Hours are 7am - 8pm EST Monday - Friday and 7am - 430pm EST
**Sat and Sunday. Set Rotation.
Position Summary
The Clinical Pharmacist Advisor supports Medicare Part D members and providers by reviewing pharmacy benefit requests and ensuring accurate, timely case processing. This role is responsible for setting up cases, reviewing clinical documentation, obtaining additional information from providers when necessary, and making clinically appropriate decisions in accordance with Medicare guidelines, drug compendia, and CMS timelines.
This is an excellent opportunity to join a leading healthcare organization focused on delivering high-quality service and compliant Medicare Part D case management.
Key Responsibilities
*Review Medicare Part D appeals and pharmacy benefit requests for accuracy and completeness.
*Evaluate clinical documentation and internal case notes to support appropriate case decisions.
*Contact healthcare providers to obtain additional clinical information when needed.
*Document all case activity clearly, accurately, and in compliance with CMS and internal guidelines.
*Apply clinical judgment using drug compendia, Medicare guidance, and established work instructions.
*Meet CMS-required turnaround times, departmental productivity goals, and quality standards.
*Participate in coaching, development discussions, and performance feedback with leadership.
Requirements:
**Bachelor's Degree in Pharmacy or Doctor of Pharmacy (PharmD).
**Active pharmacist license in good standing in the state of residence.
**Verifiable High School Diploma or GED.
**Strong clinical judgment and attention to detail.
**Excellent written and verbal communication skills.
**Ability to work independently in a remote environment while meeting productivity and quality expectations.
Preferred Qualifications
**Previous experience in a Managed Care or Pharmacy Benefit Management (PBM) environment.
**Prior Medicare Part D experience is a plus.
Contract
Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.
At Randstad, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact HRsupport@randstadusa.com.
Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Randstad offers a comprehensive benefits package, including: medical, prescription, dental, vision, AD&D, and life insurance offerings, short-term disability, and a 401K plan (all benefits are based on eligibility).
This posting is open for thirty (30) days.
It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.
Job Tags
Contract work, Temporary work, Work experience placement, Remote work, Monday to Friday