Clinical Pharmacist Advisor

Date Posted: 07/23/2026 Hiring Organization: Rose International Position Number: 504641 Industry: Pharmaceutical/Healthcare Job Title: Clinical Pharmacist Advisor Job Location: Remote, USA Work Model: Remote Work Model Details: NY, NJ, CT, Northeast Region Shift: Training is M-F from 9am-5:30pm EST; Business Hours are 7am - 8pm EST Monday - Friday and 7am - 430pm EST Sat and Sunday Employment Type: Temporary FT/PT: Full-Time Estimated Duration (In months): 13 Min Hourly Rate($): 51.00 Max Hourly Rate($): 53.00 Must Have Skills/Attributes: Managed Care, Medicare, Pharmaceutical, Quality Assurance Experience Desired: Managed Care, Medicare, PBM, or related healthcare pharmacy experience (2+ yrs); Clinical documentation review, coverage determination, and application of Medicare guidelines (2+ yrs); Data entry, case processing, and working in a productivity-driven environment (2+ yrs); PBM experience is highly preferred (1 yrs) Required Minimum Education: Bachelor’s Degree Preferred Education: Ph.D / Doctorate Required Certifications/Licenses: Active Registered Pharmacist license in good standing in the state of residence C2C is not available Job Description Required Education: Bachelor's Degree in Pharmacy (B.Pharm) or Doctor of Pharmacy (Pharm.D.) from an accredited institution Required License/Certification Active Registered Pharmacist license in good standing in the state of residence Required Qualifications/Skills/Experience Minimum 2 years of pharmacist experience in managed care, pharmacy, or related healthcare environment Active pharmacist license in good standing in state of residence Strong attention to detail and ability to accurately review clinical documentation Ability to read, analyze, and interpret medical correspondence, business documents, technical procedures, and Medicare regulations Strong verbal and written communication skills Ability to manage multiple priorities in a fast-paced, highly regulated environment Ability to maintain accurate documentation and meet productivity, quality, and CMS-mandated timelines Strong computer proficiency, including Microsoft Excel and Microsoft Word Ability to work independently in a productivity-driven environment Experience with data entry and navigating multiple systems simultaneously Ability to work on camera during training sessions, supervisor meetings, and team meetings Dedicated, quiet work-from-home environment Wired internet connection with minimum speeds of 25 Mbps download and 5 Mbps upload Preferred Qualifications/Skills/Experience Previous experience in a Pharmacy Benefit Manager (PBM) environment Previous experience in managed care or Medicare operations Experience in institutional healthcare settings Knowledge of Microsoft Access, PowerPoint, and Visio Experience supporting Medicare Part D or Medicare appeals processes Remote Managed Care Pharmacist (Medicare) Overview The Clinical Pharmacist Advisor supports Medicare members, providers, and prescribers by reviewing pharmacy benefit requests, ensuring accurate case setup, evaluating clinical information, and supporting coverage determination processes in accordance with Medicare guidelines and regulatory requirements This role is responsible for reviewing clinical documentation, applying professional clinical judgment, and ensuring timely, accurate processing of requests while maintaining compliance with CMS regulations, quality standards, and productivity expectations The position requires strong analytical skills, attention to detail, and the ability to interpret clinical documentation, Medicare guidance, and technical procedures The Clinical Pharmacist Advisor may conduct outreach to providers to obtain additional clinical information needed for case review and decision-making Success in this role requires excellent communication skills, adaptability to evolving work instructions, proficiency with technology, and the ability to work independently in a fully remote environment while maintaining high-quality service standards Job Duties Review and process Medicare pharmacy benefit requests and appeals Accurately establish and document cases in applicable systems Review clinical documentation and apply Medicare guidelines to support coverage determinations Conduct outreach to providers, prescribers, and members when additional information is required Interpret medical correspondence, technical procedures, and Medicare regulations Ensure compliance with CMS timelines, quality standards, and productivity expectations Utilize clinical judgment and drug compendia resources to support case reviews Maintain complete and accurate case documentation Follow departmental procedures, work instructions, and regulatory requirements Participate in coaching sessions, performance feedback discussions, and professional development activities Navigate multiple systems and applications while performing data entry tasks Support a positive member and provider experience through professional communication Dress Code Professional appearance required during video meetings and training sessions #CV1 Only those lawfully authorized to work in the designated country associated with the position will be considered. Please note that all Position start dates and duration are estimates and may be reduced or lengthened based upon a client’s business needs and requirements. Benefits For information and details on employment benefits offered with this position, please visit here. Should you have any questions/concerns, please contact our HR Department via our secure website. California Pay Equity For information and details on pay equity laws in California, please visit the State of California Department of Industrial Relations' website here. Rose International is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender (expression or identity), national origin, arrest and conviction records, disability, veteran status or any other characteristic protected by law. Positions located in San Francisco and Los Angeles, California will be administered in accordance with their respective Fair Chance Ordinances. If you need assistance in completing this application, or during any phase of the application, interview, hiring, or employment process, whether due to a disability or otherwise, please contact our HR Department. Rose International has an official agreement (ID #132522), effective June 30, 2008, with the U.S. Department of Homeland Security, U.S. Citizenship and Immigration Services, Employment Verification Program (E-Verify). (Posting required by OCGA 13/10-91.).