Clinical Pharmacist Advisor Medicare # 26-23269
Please note: Actual location may vary., RIJob$53–57/hrSeen 3w agoSeen in employer's feed 4 days ago
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Requirements
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Job overview
The Clinical Pharmacist Advisor Medicare ensures accurate case setup and clinical review of Medicare appeals, adhering to CMS timelines and guidelines while documenting decisions and communicating with providers. The role applies clinical judgment using drug resources, follows productivity standards, and participates in development discussions for continuous improvement.
Skills & qualifications
Skills
Qualifications
Full job description
$53-$57 per hour
Please note: Actual location may vary., RI
Right to Hire
Duration: 12 Month
Job Description:
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Shift: Business Hours are 7am - 8pm EST Monday - Friday and 7am - 430pm EST Sat and Sunday. Set Rotation.
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Licensed Registered Pharmacist in state of residence
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The role involves ensuring the accuracy of case setup and clinical review of Medicare appeals cases by thoroughly reviewing internal notes or fax requests for pertinent information, providing clear and concise documentation, and contacting providers when necessary to obtain clinical details for case decisions.
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It requires adherence to work instructions and Medicare guidelines to ensure proper case processing.
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The position also demands compliance with CMS-mandated timelines, as well as departmental productivity and quality standards.
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Clinical judgment and knowledge must be applied effectively, utilizing drug compendia resources, evolving work instructions, and CMS Medicare guidance.
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Additionally, the role includes participating in development discussions and receiving feedback from the direct supervisor to support continuous improvement.
Responsibilities:
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The role involves ensuring the accuracy of case setup and clinical review of Medicare appeals cases by thoroughly reviewing internal notes or fax requests for pertinent information, providing clear and concise documentation, and contacting providers when necessary to obtain clinical details for case decisions.
-
It requires adherence to work instructions and Medicare guidelines to ensure proper case processing.
-
The position also demands compliance with CMS-mandated timelines, as well as departmental productivity and quality standards.
-
Clinical judgment and knowledge must be applied effectively, utilizing drug compendia resources, evolving work instructions, and CMS Medicare guidance.
-
Additionally, the role includes participating in development discussions and receiving feedback from the direct supervisor to support continuous improvement
Experience:
- Previous experience in Managed Care/PBM environment (preferred).
Skills:
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Knowledge of Access, Power Point, and Visio is preferable.
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Must be computer literate – knowledge of Excel and Word.
Education:
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Bachelor's degree in pharmacy or Pharm D. required.
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Must have an active license in good standing in state of residence.
About US Tech Solutions:
US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit www.ustechsolutions.com (http://www.ustechsolutionsinc.com) .
US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, colour, religion, sex, sexual orientation, gender identity,
national origin, disability, or status as a protected veteran.
AI Statement: By applying, you acknowledge that AI-assisted tools may be used during hiring.
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