Medicare Advisor Clinical Pharmacist

Job Overview

We are seeking a dedicated Clinical Pharmacist Advisor for our Medicare division. This role is essential in providing support to Medicare Part D members and their providers while addressing inquiries related to pharmacy benefits. As part of a prestigious healthcare organization, you will play a pivotal role in ensuring compliance with Medicare guidelines and delivering exemplary service.

Key Responsibilities

• Accurately establish and review Medicare appeals cases to ensure compliance and quality standards.
• Conduct thorough evaluations of clinical information and internal documentation for decision-making.
• Engage with healthcare providers to obtain necessary clinical data for case resolutions.
• Document case reviews with precision and clarity in alignment with Medicare timelines and guidelines.
• Utilize clinical judgment and relevant compendia resources to support case processing and decision-making.
• Actively participate in ongoing discussions with supervisors for personal and professional development.
  
  

Required Skills

• Active pharmacist license in the state of residence with a good standing status.
• Proficiency in utilizing multiple software platforms, including Microsoft Office and data management systems.
• Strong oral and written communication skills to effectively convey information.
• Competence in data entry and multitasking within a fast-paced and regulated environment.
• Familiarity with drug compendia (such as Micromedex, Lexicomp) to enhance case evaluations.
  
  

Qualifications

• High School Diploma or GED is required.
• Bachelor's degree in Pharmacy or Pharm D is mandatory.
• A minimum of two years of experience as a pharmacist is necessary.
  
  

Career Growth Opportunities

Joining our team not only offers the chance to engage in meaningful work but also facilitates continuous professional development through interaction with healthcare professionals. You will have the opportunity to participate in developmental discussions, receiving valuable feedback to further enhance your skills and expertise.

Company Culture And Values

Our organization prides itself on fostering a collaborative and positive work environment. We value team engagement and are committed to creating a workplace that encourages contributions from all employees, ensuring a supportive atmosphere for everyone involved.

Networking And Professional Opportunities

This position enables you to build valuable connections within the healthcare industry, facilitating opportunities for skill development and collaborative initiatives among professionals across the sector.

Employment Type: Contractor