Pharmacist

Pharmacist – Managed Care / MedicareLocation: RemoteDuration: 12-Month ContractPay Rate: $53–$55/hour on W2 (Negotiable)Position OverviewWe are seeking a licensed Pharmacist with experience in Managed Care, Medication Therapy Management (MTM), Prior Authorization (PA), Medicare Part B, or Medicare Part D. The ideal candidate will support pharmacy operations by reviewing prescriptions, conducting clinical evaluations, processing pharmacy claims, performing prior authorization reviews, and ensuring compliance with CMS guidelines and health plan policies.Key ResponsibilitiesReview, verify, and evaluate prescriptions for clinical appropriateness and coverage eligibility.Perform Prior Authorization (PA) reviews using established clinical guidelines and health plan criteria.Conduct Medication Therapy Management (MTM) interventions and provide medication counseling to optimize patient outcomes.Process and adjudicate pharmacy claims, including Medicare Part B and/or Medicare Part D claims when applicable.Ensure compliance with CMS regulations, health plan policies, and pharmacy best practices.Resolve claim denials, reimbursement issues, and coverage determinations.Collaborate with physicians, patients, and insurance providers to obtain required clinical documentation.Counsel patients on medication therapy, formulary alternatives, and pharmacy benefits.Maintain accurate documentation while ensuring compliance with HIPAA and organizational policies.Participate in quality improvement initiatives and support operational excellence.Required QualificationsActive Pharmacist (RPh) license in good standing.PharmD or Bachelor's Degree in Pharmacy from an accredited institution.Experience in Managed Care, MTM, Prior Authorization, Medicare Part B, or Medicare Part D.Knowledge of pharmacy claims adjudication, pharmacy benefit management, CMS regulations, and clinical guidelines.Strong analytical, communication, and problem-solving skills.Ability to work independently in a fast-paced remote environment.Preferred QualificationsExperience working with PBMs, Health Plans, Specialty Pharmacy, Mail Order, Retail Pharmacy, or Ambulatory Care.Familiarity with pharmacy management systems and electronic prescription platforms.Experience with formulary management, medication utilization review, and reimbursement processes.Work Schedule8-hour shifts on a rotating schedule.Monday – Friday: Between 7:00 AM – 8:00 PM EST.Saturday & Sunday: Between 7:00 AM – 4:30 PM EST.Candidates must be flexible to work assigned shifts, including weekends.Training & AttendanceAttendance is mandatory during the onboarding and training period.First 8 weeks: Monday–Friday, 9:00 AM – 5:30 PM EST.No planned time off should be scheduled during the initial training period.