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Pharmacist – Clinical Pharmacist Advisor Medicare

ICONMA

Role overview

Qualifications

  • Previous experience in Managed Care/PBM environment (preferred)
  • Bachelor's degree in pharmacy or Pharm D. required
  • Must have an active license in good standing in state of residence

Responsibilities

  • Ensure the accuracy of case setup and clinical review of Medicare appeals cases
  • Adhere to work instructions and Medicare guidelines for proper case processing
  • Comply with CMS-mandated timelines, departmental productivity and quality standards
  • Apply clinical judgment and knowledge using drug compendia resources and CMS Medicare guidance

Key facts

Hard skills

Case Assessment Internal Documentation Provider Network Management Managed Care Project Collaboration

Other skills

  • Detail Oriented
  • Problem Solving

About the company

ICONMA logo

ICONMA

Management Consulting

We provide Professional Staffing Services & Project-Based Solutions for a broad range of Fortune 500 organizations. ICONMA is a certified Woman-Owned staffing company and was founded in 2000. ICONMA’s corporate headquarters is in Troy, Michigan, and has 15+ locations worldwide. What makes ICONMA stand out in a fiercely competitive industry? *We provide integrated, full lifecycle services across a broad range of business and technical platforms. *No single company can duplicate our full range of staffing and permanent recruiting services nationwide. *Proven track record of attracting and retaining exceedingly skilled professional workers in a highly competitive market. SERVICES OFFERED Staff Augmentation (Contract, Contract to Hire, Direct Hire, Single Source) Data Analysis Project-Based Services & Solutions Hire Train Deploy Service Model Offshore Staff Augmentation Payroll Services AREAS OF EXPERTISE - Information Technology - Engineering - Business Professional - Accounting/Finance - Admin/Clerical/Call Center - Healthcare/Clinical/Scientific - Marketing/Creative mail linkedin@iconma.com Phone (888) 451-2519 Website http://www.iconma.com

Company details

Company typeLarge
IndustryManagement Consulting
Company size1001 - 5000

Links

Website LinkedIn See all jobs

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Job description

Our Client, a Retail Pharmacy company, is looking for a Pharmacist – Clinical Pharmacist Advisor Medicare for their Remote location.
 
Responsibilities:
  • 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.
 
Requirements:
  • Previous experience in Managed Care/PBM environment (preferred).
  • Bachelor's degree in pharmacy or Pharm D. required.
  • Must have an active license in good standing in state of residence.
 
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MR

Marcus Rivera

Chief Revenue Officer

m.rivera@company.com
linkedin.com/in/marcusrivera
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