Remote Clinical Pharmacist - Medicare Appeals
Remote Clinical Pharmacist – Medicare Appeals
Fully Remote
A-Line Staffing is hiring Clinical Pharmacists for a fully remote opportunity supporting Medicare Part D appeals and clinical review.
This is a great opportunity for a pharmacist with experience in managed care, PBM, clinical pharmacy, prior authorization, medication review, or other detail-oriented pharmacy environments who is interested in transitioning into a remote clinical role.
Opportunity for full-time employment contingent on performance.
Position Details
- Position: Clinical Pharmacist Advisor – Medicare
- Job Type: Full-Time
- Work Arrangement: 100% Remote – Never Onsite
- Start Date: November 9, 2026
- Schedule: Set rotation based on business needs
- Business Hours: 7:00 AM–8:00 PM EST, Monday–Friday
- Weekend Hours: 7:00 AM–4:30 PM EST, Saturday–Sunday
- Training: Monday–Friday, 9:00 AM–5:30 PM EST
- Initial Training Period: Approximately 8–10 weeks
Position Summary
As a Clinical Pharmacist Advisor Medicare, you will support Medicare Part D members and providers with requests related to their pharmacy benefits.
The pharmacist will ensure cases are accurately established, review clinical information to support decision-making, conduct provider outreach when additional information is needed, and ensure decisions are accurate and compliant with Medicare requirements, clinical resources, and applicable timelines.
This position requires strong attention to detail, clinical knowledge, computer skills, organization, and the ability to work independently in a productivity-driven remote environment.
Key Responsibilities
- Review and accurately set up Medicare Part D appeals cases.
- Review internal notes, fax requests, and clinical documentation for relevant information.
- Perform clinical review of cases and apply appropriate clinical judgment.
- Review information needed to support accurate case decisions.
- Contact providers when additional clinical information is required.
- Document all case activity clearly and accurately.
- Follow established work instructions and Medicare guidelines.
- Meet CMS-mandated timelines for case processing.
- Meet departmental productivity and quality expectations.
- Utilize drug compendia, clinical resources, work instructions, and Medicare guidance.
- Maintain accurate and timely documentation throughout the review process.
- Participate in development discussions and incorporate feedback from supervisors.
- Navigate multiple computer applications while utilizing two monitors/screens.
- Perform data entry and other administrative duties associated with case processing.
- Make outbound provider calls when necessary.
Required Qualifications
- Bachelor’s degree in Pharmacy or PharmD
- Active Registered Pharmacist license in good standing in the state of residence
- Verifiable high school diploma or GED
- Strong computer literacy
- Experience with Excel and Word
- Ability to navigate multiple computer applications
- Strong data-entry and documentation skills
- Excellent attention to detail
- Strong organizational and interpersonal skills
- Ability to work independently
- Ability to maintain productivity and quality standards in a remote environment
Preferred Experience
- Previous Managed Care or PBM experience
- Prior Authorization experience
- Medicare Part D experience
- Appeals or clinical review experience
- Pharmacy benefit management experience
- Experience working with clinical documentation
- Experience in a productivity-driven call center or healthcare environment
Remote Work Requirements
This is a fully remote position. Candidates must have an appropriate home environment and technology setup to successfully perform the job.
Internet Requirements
Candidates must provide their own high-speed internet.
Minimum required:
- 25 Mbps download
- 5 Mbps upload
- Wired internet connection
Internet speed must be verified through Speedtest.net.
Resume Requirement – Internet Speed Test
A screenshot of the internet speed test MUST be placed at the very top of the resume.
Resume Requirement – Pharmacist License
An active pharmacist license MUST also be shown at the top of the resume.
The license information should clearly demonstrate:
- Pharmacist name
- State
- License number
- Expiration date
- Current/active status
A screenshot of the active license should be included.
Work-From-Home Requirements
Candidates must:
- Have a dedicated, quiet and separate workspace.
- Be able to work without interruptions throughout the scheduled shift.
- Prevent other household members from viewing computer screens or documents.
- Ensure telephone conversations cannot be overheard by others.
- Maintain confidentiality of all member, provider and company information.
- Have a smartphone capable of supporting required authentication/VPN functionality.
- Be comfortable working independently in a productivity-driven environment.
- Be able to sit and focus on work for the duration of the scheduled shift.
Computer & Technical Requirements
The primary function of this role involves data entry, clinical documentation, and navigating multiple computer applications using two screens.
Knowledge of Microsoft Access, PowerPoint and Visio is preferred.
Training & Attendance Requirements
Attendance is extremely important, particularly during the initial training period.
Training Schedule:
Monday–Friday
9:00 AM–5:30 PM EST
Candidates must be available for the initial 8 weeks of training and should not have planned vacation or other scheduling conflicts during this period.
After training, shifts will be assigned based on business needs.
Candidates must be able to work an assigned 8-hour shift between 7:00 AM and 8:00 PM EST, Monday through Friday.
The position also requires one weekend day or participation in a weekend rotation, depending on business needs.
Candidate Questionnaire
Please review and confirm the following with candidates before submission:
- Are you available Monday–Friday from 9:00 AM–5:30 PM EST for the first 8 weeks of training, with no planned vacation or time off during this period?
- After training, are you able to work an assigned 8-hour shift between 7:00 AM and 8:00 PM EST?
- Are you able to work one weekend day or a weekend rotation as assigned based on business needs?
- Do you have a dedicated, quiet and separate workspace for this fully remote position?
- Do you have wired internet with a minimum of 25 Mbps download and 5 Mbps upload?
- Have you provided a Speedtest.net screenshot showing your internet provider, download speed and upload speed?
- Do you have an active pharmacist license in good standing in the state where you reside?
- Are you able to sit and maintain focus without interruptions for the duration of your scheduled shift?
- Do you have experience with data entry and navigating multiple computer applications, preferably while using two screens?
- Are you comfortable working independently in a productivity- and quality-driven environment?
- Are you comfortable maintaining a professional, engaged and positive approach while working remotely as part of a team?
Important Hiring Information
- Start Date: November 9, 2026
- Offer Extended By: October 12, 2026
- Offer Acceptance By: October 15, 2026
- Must Clear Prior To: October 29, 2026 at 5:00 PM EST
