Licensed Clinical Pharmacist Reviewer

To support the contract through independent clinical review, the part-time Licensed Clinical Pharmacist Reviewer will evaluate Medicare Part D reconsideration appeals, assess coverage eligibility, and ensure compliance with regulations in a remote environment. Key responsibilities Perform independent clinical and policy reviews of Medicare Part D reconsideration appeals Analyze clinical documentation and pharmacy claims to determine coverage eligibility and payment appropriateness Draft clear clinical recommendations and maintain accurate documentation of review findings Required qualifications Doctor of Pharmacy (PharmD) or Bachelor of Science in Pharmacy required Active, unrestricted pharmacist license in good standing Five or more years of experience in Medicare Part D operations or related fields Strong knowledge of Medicare Part D regulations and appeals processes Experience in clinical assessment and analytical skills