Clinical Pharmacist Advisor – Medicare (Remote)

Job Posting: Clinical Pharmacist Advisor – Medicare (Remote) Position Title: Clinical Pharmacist Advisor – Medicare Location: 100% Remote (U.S. Based) Start Date: July 20, 2026 Pay Rate: $53.00/hr - 55.00 Opportunity: Potential for Full-Time Conversion Based on Performance Important Candidate Notice All meetings require camera participation. As part of the hiring process and assignment expectations, candidates must be comfortable being on camera during training, supervisor meetings, and team meetings. Hiring Timeline Offer Extended By: ASAP Clear to Start Deadline: Prior to July 10, 2026 Start Date: July 20, 2026 Please DO NOT resubmit candidates previously submitted to CVS ramp roles (2023–2025) or candidates rejected by the hiring team. Training Schedule (Mandatory) Duration: First 8–10 weeks Monday – Friday 9:00 AM – 5:30 PM EST No time off permitted during training Attendance is critical during onboarding and training. Production Schedule (After Training) Set rotational schedule based on business needs: Monday – Friday: 7:00 AM – 8:00 PM EST Saturday & Sunday: 7:00 AM – 4:30 PM EST Candidates must be flexible to work: Assigned 8-hour shifts Weekend rotation OR one weekend day consistently Productivity-driven remote workflow Position Summary The Clinical Pharmacist Advisor – Medicare supports Medicare Part D members and providers by reviewing and processing pharmacy benefit requests, Medicare appeals, and clinical authorization cases while ensuring compliance with CMS Medicare regulations, compendia guidance, productivity metrics, and quality standards. This role requires strong clinical judgment, exceptional documentation skills, and the ability to independently review complex clinical information to support timely, accurate case decisions. Key Responsibilities Review Medicare Part D pharmacy appeals and benefit requests Ensure accurate clinical case setup and documentation Review internal notes, faxes, and supporting clinical documentation Contact providers to obtain additional clinical details when required Apply CMS Medicare guidelines and drug compendia resources Ensure compliance with required turnaround timelines Maintain departmental productivity and quality metrics Navigate multiple systems and perform high-volume data entry Participate in coaching, feedback, and performance development discussions Collaborate professionally with internal teams and providers Required Qualifications Active Registered Pharmacist license in state of residence (must be active and in good standing) Bachelor of Pharmacy or PharmD required Previous Managed Care / PBM experience preferred Strong Medicare Part D knowledge preferred Excellent clinical judgment and documentation accuracy Advanced computer literacy Experience with: Microsoft Excel Word Access (preferred) PowerPoint (preferred) Visio (preferred) Ability to work independently in a productivity-driven remote environment Remote Work Requirements Candidates must have: ✔ Dedicated private workspace ✔ Quiet, distraction-free environment ✔ Wired internet connection only ✔ Minimum internet speed: 25 Mbps Download 5 Mbps Upload ✔ Dual-monitor workflow capability ✔ Ability to sit and focus for full scheduled shift Required Resume Submission Documents Must appear at TOP of resume submission: 1. Internet Speed Test Screenshot Must include screenshot from: www.speedtest.net Must clearly show: Download speed Upload speed Date/time visible 2. Pharmacist License Screenshot Must clearly display: Candidate name License number State of residence Expiration date Active status Candidate Questionnaire (Must Be Completed & Placed on Resume) 1. Training Availability Do you have any conflicts with mandatory training ( M–F, 9:00 AM–5:30 PM EST for 8–10 weeks ) or planned time off during assignment? 2. Shift Flexibility Are you able to work assigned 8-hour shifts between 7:00 AM–8:00 PM EST , including weekend rotation or one weekend day? 3. Dedicated Workspace Do you have a dedicated, quiet, separate workspace for remote work? 4. Wired Internet Do you have wired internet meeting minimum 25 Mbps download / 5 Mbps upload ? (Attach screenshot) 5. Shift Focus Requirement Can you remain seated and focused with no interruptions for the full shift? 6. Data Entry Experience Do you have experience navigating multiple systems and performing high-volume data entry using dual screens? 7. Active Pharmacist License Do you have an active pharmacist license in good standing in your state of residence? 8. Independent Productivity Are you comfortable working independently in a productivity-driven environment? 9. Positive Team Engagement Do you demonstrate a positive, collaborative, and engaged work style? Interview Process Virtual Teams Interview with CVS Supervisors Candidates must: Present professionally Have camera enabled Be prepared for behavioral and workflow-based questions Ideal Candidate We are seeking pharmacists who are: Detail-oriented Clinically sharp Medicare/PBM knowledgeable Comfortable with remote structured workflows Highly productive Positive and coachable Strong written/documentation communicators Position Summary The Clinical Pharmacist Advisor – Medicare supports Medicare Part D members and providers by reviewing and processing pharmacy benefit requests, Medicare appeals, and clinical authorization cases while ensuring compliance with CMS Medicare regulations, compendia guidance, productivity metrics, and quality standards. This role requires strong clinical judgment, exceptional documentation skills, and the ability to independently review complex clinical information to support timely, accurate case decisions. Key Responsibilities Review Medicare Part D pharmacy appeals and benefit requests Ensure accurate clinical case setup and documentation Review internal notes, faxes, and supporting clinical documentation Contact providers to obtain additional clinical details when required Apply CMS Medicare guidelines and drug compendia resources Ensure compliance with required turnaround timelines Maintain departmental productivity and quality metrics Navigate multiple systems and perform high-volume data entry Participate in coaching, feedback, and performance development discussions Collaborate professionally with internal teams and providers