Local Contract Pharmacist
Remote, AL
LanceSoft
5x8 hrs, Days

The Clinical Pharmacist Advisor – Medicare Part B Operations supports Medicare Part B members, prescribers, and providers by reviewing and processing coverage requests for injectable and infused medications covered under medical benefits. This role is responsible for accurate case setup, clinical review, provider outreach, documentation, and timely decision-making in accordance with Medicare guidelines, CMS regulations, clinical compendia, and internal quality standards.

The ideal candidate demonstrates strong clinical knowledge, attention to detail, effective communication skills, and the ability to thrive in a fast-paced, highly regulated environment while delivering exceptional service.

This is a full-time, remote, non-exempt position requiring schedule flexibility based on business needs.

Key Responsibilities

Case Review & Processing

• Review and process Medicare Part B coverage requests for injectable and infused medications.
• Accurately establish and manage cases by reviewing clinical documentation and applying established work instructions.
• Analyze medical records, business correspondence, technical procedures, and Medicare regulations to support coverage determinations.
• Ensure accurate and timely processing while meeting CMS and departmental performance standards.

Provider & Member Outreach

• Conduct outbound calls to providers, prescribers, and members to obtain additional clinical or administrative information needed to complete case reviews.
• Communicate professionally, clearly, and empathetically while delivering a high-quality customer experience.
• Collaborate effectively with internal and external stakeholders to resolve case-related issues.

Documentation & Compliance

• Maintain complete, accurate, and concise documentation of all case activities across applicable systems.
• Ensure all cases are processed and closed within CMS-required turnaround times and internal quality expectations.
• Apply clinical judgment using Medicare guidance, drug compendia, and current work instructions to support accurate coverage decisions.
• Adhere to all regulatory, compliance, and organizational policies and procedures.

Continuous Learning & Development

• Maintain current knowledge of Medicare regulations, clinical guidelines, systems, and evolving work instructions.
• Participate in training, coaching, quality reviews, and performance development activities.
• Support continuous process improvement initiatives and maintain high productivity and quality standards.

Qualifications

Required

• Bachelor of Science in Pharmacy or Doctor of Pharmacy (PharmD) degree.
• Active pharmacist license in good standing in the state of residence.
• Strong analytical, clinical, and problem-solving skills.
• Excellent verbal and written communication skills.
• Ability to manage multiple priorities in a fast-paced, highly regulated environment.
• Strong attention to detail and organizational skills.

Preferred

• Previous experience in managed care, pharmacy benefit management (PBM), institutional healthcare, pharmacy operations, or a related healthcare environment.
• Experience interpreting Medicare guidelines and coverage policies.
• Prior utilization management or prior authorization experience.

Work Schedule

• Business Hours: Monday–Friday, 7:00 AM–8:00 PM EST, with rotating weekends and holidays.
• Training Schedule: Monday–Friday, 9:00 AM–5:30 PM EST.

Work Environment

• Remote, full-time position.
• Schedule flexibility required to meet business and operational needs.
• Opportunity to contribute to high-quality Medicare Part B clinical operations while supporting positive member and provider experiences.