Clinical Pharmacist Advisor Medicare - Integrated Resources, Inc

***Please DO NOT resubmit candidates that were submitted on previous ramp roles (2023-2024) or rejected by Hiring Team


Knowledge of Access, Power Point, and Visio is preferable.
Must be computer literate knowledge of Excel and Word.
Licensed Registered Pharmacist in state of residence

***Must provide a copy Registered Pharmacist License with Resume in state of residence***
**include state & time zone on resume**
**Include a screenshot of internet speed**


As an RPh Advisor you will be directly supporting Medicare Part D members and providers with requests related to their pharmacy benefits. You will be responsible for ensuring cases are accurately set up for our members, review clinical information for decisioning the request, performing outreach to providers for more information when needed, and ensuring accurate decisions that comply with compendia and Medicare guidance and timelines. This is a great opportunity to initiate a career with a leading healthcare company by reviewing information and completing timely and accurate documentation of all Medicare Part D requests, in compliance with Medicare guidelines, while promoting a best-in-class service experience.

1. Attendance is extremely important, especially during the initial 8 weeks of training. The new hire must be available M-F from 9am-5:30pm EST for the first 8 weeks (no vacation time planned).
Do you have any conflicts with the training schedule or time off planned during assignment duration?

2. After training, our hours of operation are an 8 hours shift between 7AM - 8PM EST M-F with rotating weekend schedules 7AM - 4PM EST. they must be available for the rotating weekend.
Do you have any conflicts working an assigned 8-hour shift between 7AM to 8PM EST - 8hours per day M-F or 7AM- 4PM EST rotating weekends

3. This is a work from home (WFH) position; must have a dedicated quiet, separate space in which to work with wired internet meeting 25mbps min download and 5mbps minimum upload speed. Previous WFH experience is preferred.
Do you have a separate workspace with no interruptions?
Please include a screen shot of internet speed

4. Must be able to sit and focus on work for the duration of shift.
Are you able to sit and focus with no interruptions for entire shift?

5. Data entry and navigating multiple computer applications while utilizing two screens is the primary function of job (possible outbound calls needed). A job history demonstrating this is recommended.
Do you have data entry experience?

6. Active Pharmacist license is required in the state you live in.

7. Successfully worked independently in a data entry, productivity driven role is preferred
Are you able to work independently?

8. As a company we strive for a team that is engaged and positive so candidates that demonstrate this would be ideal
Do you feel you have the engagement and positive attitude to work this assignment?

Position Summary:

This position is responsible for dispensing prescriptions and coordinating clinical services for specialty drugs serviced at the branch location. This position is responsible for interacting with the health care professionals in the provision and coordination of customer care. Must also translate prescriptions, perform compounds and dispense prescribed pharmaceuticals. Must be comfortable communicating by telephone or mail, with patients and physicians for patient care. Will also be responsible for resolving orders via the EA (External Adjudication) queue.

Duties:

Ensure accuracy of case setup and clinical review of Medicare appeals cases
Review internal notes or fax requests thoroughly for pertinent information
Provide clear, concise, and accurate documentation for case reviews
Contacting providers, if needed, for clinical information to decision cases
Utilize work instructions and Medicare guidelines for accurate case processing

Comply with CMS mandated timelines and department productivity and quality standards Acquire and utilize clinical judgement and knowledge, drug compendia resources, relevant and changing work instructions, and CMS Medicare guidance Participate in development discussions receiving feedback from direct supervisor.

This is a remote role, open to qualified candidates within the United States. Operational hours are 7am-8pm ET M-F, 7am-5pm ET on weekends. The RPh Advisor is expected to show flexibility in working with a rotating schedule, including overtime, evenings, weekends, and holidays.

Experience:

- Active pharmacist license in the state of residence that is in good standing
- Ability to utilize multiple software systems, simultaneously with a 2-screen workstation setup (Windows based operations, AS400, MHK, PeopleSafe, WI database, Microsoft office applications)
- Ability to type 30 WPM or greater
- Ability to utilize compendia (Micromedex, Lexicomp, etc) to evaluate and support case decisions
- Excellent oral and written communication skills
- Ability to multi-task, prioritize, and manage time effectively in a fast-paced, highly regulated environment
- Must be able to review large volume of information, determine importance, and apply clinical knowledge to assist in outcome
- Demonstrated ability to work independently and utilize critical thinking/problem solving skills to make case decisions
- Receptive to constructive feedback and flexible in adapting to change
- Flexibility with working a rotating schedule including overtime, weekends, and holidays

Education:

High School Diploma or GED required. Bachelor's degree in pharmacy or Pharm D. also required with at least two years experience as a pharmacist. Must have an active license in good standing.

What days & hours will the person work in this position? List training hours, if different.	Mon - Fri 7am ET to 8pm ET, Weekends 7am ET to 430pm ET rotating schedule
Onsite Requirements	Fully remote (never coming onsite)