Title: Clinical Pharmacist Advisor - Remote
Mandatory skills:
managed care, PBM environment, institutional healthcare, pharmacy,
Case Review, Processing,
incoming coverage-related requests, Accurately set up cases, review documentation, apply work instructions,
business, medical correspondence, technical procedures, Medicare regulations,
Outreach, Information Gathering,
Conduct outbound calls, positive business image, Documentation, Accuracy, Compliance Standards,
CMS-mandated timelines, department productivity expectations, quality standards,
Apply clinical judgment, utilizing drug compendia resources, evolving work instructions, CMS Medicare guidance,
Continuous Learning and Development, processing coverage-related requests, infused medications, medical benefits
Description:
Position Summary
As a Clinical Pharmacist Advisor, Medicare B Operations, you will support Medicare Part B members, prescribers, and providers by processing coverage-related requests for injectable and infused medications covered under their medical benefits. You will be responsible for accurate case set up, review of 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 guidelines, CMS-mandated timelines, and internal quality standards. You will demonstrate strong attention to detail, professional verbal and written communication skills, and the ability to problem-solve in a highly regulated, fast-paced environment. This is a great opportunity to initiate a career with a leading healthcare company by reviewing information and completing timely and accurate documentation of Medicare Part B requests, in compliance with Medicare guidelines, while promoting a best-in-class service experience.
Duties
Case Review and Processing
Process incoming coverage-related requests from members and prescribers.
Accurately set up cases, review documentation, and apply work instructions to ensure correct and timely processing.
Read, analyze, and interpret business and medical correspondence, technical procedures, and Medicare regulations to support decision-making.
Outreach and Information Gathering
Conduct outbound calls to members and providers to obtain missing or additional information required to complete requests.
Communicate clearly, professionally, and empathetically while projecting a positive business image.
Documentation, Accuracy, and Compliance Standards
Provide clear, concise, and accurate documentation of all case activity across systems.
Ensure all cases are properly closed and meet CMS-mandated timelines, department productivity expectations, and quality standards.
Apply clinical judgment and knowledge effectively, utilizing drug compendia resources, evolving work instructions, and CMS Medicare guidance.
Continuous Learning and Development
Acquire and maintain working knowledge of evolving work instructions, systems, and Medicare guidance.
Participate in coaching, feedback, and development discussions with direct leadership.
Experience
Previous experience in managed care, PBM environment, institutional healthcare, pharmacy, or related experience (preferred).
Education
Bachelor''s degree in pharmacy or Pharm D. required. Must have an active license in good standing in state of residence.
Notes:
This position is full-time, remote, non-exempt, and requires schedule flexibility based on business needs.
Fully remote (never coming onsite)
SAFETY SENSITIVE
Business hours: 7am–8pm EST Monday–Friday and rotating weekend/holiday. Training: 9am–5:30pm EST
VIVA USA is an equal opportunity employer and is committed to maintaining a professional working environment that is free from discrimination and unlawful harassment. The Management, contractors, and staff of VIVA USA shall respect others without regard to race, sex, religion, age, color, creed, national or ethnic origin, physical, mental or sensory disability, marital status, sexual orientation, or status as a Vietnam-era, recently separated veteran, Active war time or campaign badge veteran, Armed forces service medal veteran, or disabled veteran. Please contact us at for any complaints, comments and suggestions.
Contact Details :
Account co-ordinator: Keerthana Bathrappan
VIVA USA INC.
3601 Algonquin Road, Suite 425
Rolling Meadows, IL 60008
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