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Job Details

Since these are all work from home, freelance, contract and telecommute jobs, you can be based anywhere and still apply, providing you meet the employer's requirements. However, there are times when the employer will ask for applicants from a specific location, this will be clearly stated in the job posting below.

Title: Part D Pharmacist
Date Posted: 2017-05-13
Location: Not mentioned
The Part D Pharmacist is responsible for assisting with the development of the Medicare Part D audit program and ensuring that audits are conducted with adherence to clinical compliance, CMS guidelines, and accuracy of the assigned business area, for our client. This will include assisting in the development of audit tools and recommending changes in processing procedures. They will have the ability, and be expected to drive change, and positively impact the accuracy and efficiency of operations by recommending actions that address error trends and root-causes of errors found during quality audits.


- Review Medicare Part D appeal and coverage determination requests by applying utilization management criteria for an internal medical review
- Review Part D appeal, coverage determination requests to ensure appropriate patient safety such as drug-drug interactions, drug-disease interactions, drug-age precautions, therapeutic duplications, and overutilization
- Maintaining excellent understanding of evidence based medicine clinical guidelines
- Identifies billing, benefit, and coding errors and track these errors to resolution
- Ensure organizational compliance with Federal and State governmental (e.g., CMS, Medicaid, etc.), departmental, and company guidelines
- Perform specific quality reviews for specific requests as needed, ad hoc
- Perform weekly, monthly and/or quarterly quality reviews as directed to support each function within the end to end process, at each program level
- Provide timely and constructive feedback on audits to drive quality improvement
- Provide effective communication to engage and develop cross functional staff in a virtual environment
- Delivers communications positively and is supportive of organizational goals and objectives
- Collaborates with matrix partners in Compliance, Claims, National Quality, and Networks to ensure objectives and standards are met, policies and procedures are followed, gaps identified and closed, communications are clear

Basic Qualifications

- Active Pharmacist License in home state, with no restrictions
- Ability to obtain additional license elsewhere, if needed
- Previous experience with clinical review of Medicare Part D coverage determinations, appeals and grievance and claims audits, preferably for a health plan or a pharmacy organization
- Strong time management, communication skills, and organizational skills required
- Strong technical skills, to navigate multiple systems and tools at once, with ease

Preferred Qualifications

- Previous successful work at home experience
- Previous leadership or people management experience preferred

Apply via this link only:

keywords: pharmacist, part d pharmacist


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Company: BroadPath Healthcare Solutions
Contact person: Not mentioned
Contact information: info@broad-path.com (DO NOT APPLY VIA THIS EMAIL ADDRESS)