Clinical Pharmacist - Medicare / Prior Auth

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.