Remote Clinical Pharmacist (PBM/Medicare)

Job description: Remote Clinical Pharmacist (PBM/Medicare) Location: 100% Remote (U.S.) Start Type: Class Start (Set Date) - May 18th, 2026 Openings: 50 Pay Rate: $53.00 Assignment Type: Contract (High Conversion Potential) Position Overview We are hiring Clinical Pharmacist Advisors (Medicare) to support a leading healthcare organization in a fully remote capacity. In this role, you will review and process Medicare Part D pharmacy benefit requests, including prior authorizations and appeals, ensuring accurate and compliant clinical decisions. This is a high-volume, production-driven role ideal for pharmacists with experience in PBM, managed care, prior authorization, or coverage determination environments. Key Responsibilities • Review and evaluate Medicare Part D prior authorization and appeals cases • Analyze clinical documentation, internal notes, and faxed requests for completeness and accuracy • Apply clinical judgment using drug compendia, CMS guidelines, and plan criteria • Make approval/denial determinations in alignment with Medicare regulations and timelines • Perform provider outreach to obtain additional clinical information when needed • Ensure accurate and thorough documentation of all case decisions • Maintain compliance with CMS guidelines, internal workflows, and quality standards • Meet productivity, turnaround time, and accuracy metrics in a fast-paced environment • Navigate multiple systems simultaneously while managing a high case volume Required Qualifications • Active Pharmacist (RPh) license in state of residence (must be in good standing) • PharmD or Bachelor’s in Pharmacy • Strong computer proficiency (Excel, Word required) • Ability to work independently in a remote, production-based environment • Experience with data entry and multi-system navigation Preferred Experience (Highly Sought After) • Prior Authorization / Coverage Determinations / Appeals • Medicare Part D or Managed Care/PBM experience • Experience with: • Formulary reviews • Step therapy / quantity limits • CMS compliance and timelines • Background in organizations such as PBMs, health plans, or specialty pharmacy • Previous remote pharmacist experience Work Schedule • Business Hours: 8 hour shift • Monday–Friday: 7:00 AM – 8:00 PM EST • Saturday–Sunday: 7:00 AM – 4:30 PM EST • Set rotation schedule (includes weekends) • Training: • Monday–Friday, 9:00 AM – 5:30 PM EST • First 8–10 weeks (no time off permitted during training) Remote Requirements (MANDATORY) Candidates must provide the following at the top of their resume: • Internet Speed Test Screenshot (from Speedtest.net) • Minimum: 25 Mbps download / 5 Mbps upload • Active Pharmacist License Screenshot • Must include: Name, State, License #, and Expiration Date Additional Requirements: • Dedicated, quiet workspace • Ability to remain on camera during training and team meetings • Ability to sit and focus for full shift duration • Comfortable working on dual monitors and multiple systems Candidate Pre-Screen Questions (REQUIRED – Include on Resume) • Are you available for full-time training (M-F 9:00–5:30 EST for 8–10 weeks) with no planned time off? • Are you able to work any assigned 8-hour shift between 7 AM – 8 PM EST, including weekends? • Do you have a dedicated, quiet workspace for remote work? • Do you meet internet speed requirements (25/5 Mbps) and can provide proof? • Are you able to sit and focus for the full duration of your shift? • Do you have experience with data entry and navigating multiple systems simultaneously? • Do you have an active pharmacist license in your state of residence? • Are you comfortable working independently in a productivity-driven role? • Do you bring a positive, engaged attitude to a team-oriented environment?