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Clinical Pharmacist Advisor Medicare # 26-23269

US Tech Solutions

Role overview

Qualifications

  • Licensed Registered Pharmacist in state of residence
  • Bachelor's degree in pharmacy or Pharm D.
  • Active license in good standing in state of residence
  • Previous experience in Managed Care/PBM environment (preferred)

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
  • Utilize clinical judgment and knowledge effectively, using drug compendia resources and CMS guidance

Key facts

Hard skills

Other skills

  • Microsoft PowerPoint
  • Microsoft Excel
  • Communication

About the company

US Tech Solutions logo

US Tech Solutions

Staffing & Recruiting

USTECH SOLUTIONS is the largest privately owned diversity workforce partner with a global footprint. For 20+ years, we have partnered with leading MSPs and some of the world’s largest enterprises to deliver a flexible workforce. We serve Fortune 500 giants and growing businesses alike, reinventing the role of humans in a digital workforce. ‘Reinventing Human’ is about connecting you with top talent and seamlessly integrating new hires into your programs through our next gen AI powered Talent platforms. As the largest private diversity supplier in the US, we champion inclusion and unlock hidden potential. We work with leading MSPs and are a trusted strategic partner to the world’s top brands. At USTECH SOLUTIONS, we're inverting the talent hiring pyramid by offering a range of solutions from curated talent pools, workforce management services, and IT services resourcing to IC compliance. Our legacy and close affinity to the computing industry has equipped us with the expertise and vision to provision AI platform solutions that help organizations to innovate faster. Considering Statement of Work? Meet US Tech Digital (ustechdigital.com). We're helping businesses achieve digital leadership through our tailored SOW solutions, utilizing market-leading technology products and our proprietary in-house developed platform solutions. Explore our full range of services and solutions by visiting our website: ustechsolutions.com

Company details

Company typeLarge
IndustryStaffing & Recruiting
Company size1001 - 5000

Links

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Job description

Duration: 12 Month

Job Description:
  • Shift: Business Hours are 7am - 8pm EST Monday - Friday and 7am - 430pm EST Sat and Sunday. Set Rotation.
  • Licensed Registered Pharmacist in state of residence
  • 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.
 
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
Experience:
  • Previous experience in Managed Care/PBM environment (preferred).
 Skills:
  • Knowledge of Access, Power Point, and Visio is preferable.
  • Must be computer literate – knowledge of Excel and Word.
 Education:
  • Bachelor's degree in pharmacy or Pharm D. required.
  • 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.
 
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.
 
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