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?

Apply tot his job Apply To this Job