Pharmacist Operations Advisor at A-Line Staffing

About the Role

As a Pharmacist Operations Advisor, you will serve as a critical bridge between Medicare Part D members and providers, ensuring pharmacy benefit requests are handled with clinical precision and empathy. This role exists to deliver a best-in-class member experience within a fast-paced, productivity-driven healthcare environment. You will leverage your clinical judgment and pharmacy expertise to navigate complex appeals and benefit requests, ensuring strict adherence to CMS mandates and quality standards.

Your day will involve reviewing internal notes and fax requests, conducting thorough clinical reviews, and reaching out to providers to gather necessary information. You will be responsible for accurate case setup and maintaining concise, compliant documentation throughout the review process. This position offers the opportunity to work independently in a remote setting while contributing to a team dedicated to high-quality healthcare outcomes.

Hiring Process

Candidates will participate in virtual interviews conducted via Microsoft Teams. Please note that comfort with being on camera is required for both the interview process and the subsequent training period.

Work Environment & Culture

This is a dedicated work-from-home position requiring a quiet, distraction-free workspace. As a safety-sensitive role, you will be expected to maintain high focus during scheduled shifts. The team values strong attention to detail, the ability to navigate multiple systems simultaneously, and a positive attitude that fosters team engagement.

Application Instructions

To apply, please confirm your agreement to the required schedule, which includes business hours from 7:00 AM – 8:00 PM EST (Monday–Friday) and weekend hours from 7:00 AM – 4:30 PM EST (Saturday–Sunday). A rotation schedule will be established after training. Additionally, please be prepared to provide a screenshot of your active pharmacist license and a screenshot of your internet speed test results (minimum 25 Mbps download / 5 Mbps upload) as part of the application verification.

Work location

Work model: Remote

Remote

Key Responsibilities

check_circleReview and process Medicare Part D appeals and pharmacy benefit requests
check_circleConduct accurate case setup and complete clinical review documentation
check_circleApply clinical judgment and pharmacy knowledge to case decisioning
check_circleEnsure compliance with CMS mandated timelines and quality standards
check_circleMaintain accurate and concise documentation throughout the review process
check_circleUtilize Medicare guidelines, work instructions, and drug compendia resources
check_circleParticipate in coaching and development discussions with leadership
check_circleContact providers to obtain additional clinical information when needed

Requirements

verifiedActive Pharmacist license in good standing in state of residence
verified1 year experience reviewing and processing Medicare Part D appeals
verified1 year experience reviewing and processing pharmacy benefit requests
verifiedWired internet connection with minimum speeds of 25 Mbps download and 5 Mbps upload
verifiedAbility to comply with CMS and Medicare guidelines

Nice to Have

Knowledge of Access, PowerPoint, and Visio. Proficiency with Excel and Word. Data entry experience. Previous experience in a productivity-driven work environment. Positive attitude and strong team engagement skills.

Benefits & Perks

check_circle401(k) with company match available after 1 year of servicecheck_circleHealth insurance available to full-time employees after 90 dayscheck_circleDental insurance available to full-time employees after 90 dayscheck_circleLife insurance available to full-time employees after 90 daysVision insurance available to full-time employees after 90 days

Frequently asked questions about Pharmacist Operations Advisor at A-Line Staffing Solutions

What does a Pharmacist Operations Advisor at A-Line Staffing Solutions do?expand_more

In this Pharmacist Operations Advisor at A-Line Staffing Solutions role, you will review and process medicare part d appeals and pharmacy benefit requests; conduct accurate case setup and complete clinical review documentation; apply clinical judgment and pharmacy knowledge to case decisioning; and ensure compliance with cms mandated timelines and quality standards.

What are the requirements for this Pharmacist Operations Advisor role?expand_more

To qualify for the Pharmacist Operations Advisor at A-Line Staffing Solutions position, applicants should have: Active Pharmacist license in good standing in state of residence; 1 year experience reviewing and processing Medicare Part D appeals; 1 year experience reviewing and processing pharmacy benefit requests; Wired internet connection with minimum speeds of 25 Mbps download and 5 Mbps upload; and Ability to comply with CMS and Medicare guidelines.

Where is the Pharmacist Operations Advisor role at A-Line Staffing Solutions located?expand_more

Pharmacist Operations Advisor at A-Line Staffing Solutions is based in Remote. This is a remote role.

Is this Pharmacist Operations Advisor job remote, hybrid, or on-site?expand_more

A-Line Staffing Solutions has listed this Pharmacist Operations Advisor role as remote.

How much experience is required for this Pharmacist Operations Advisor role?expand_more

Pharmacist Operations Advisor at A-Line Staffing Solutions typically requires 1+ years of relevant experience at the mid level level.

What skills do you need for the Pharmacist Operations Advisor role at A-Line Staffing Solutions?expand_more

Key skills for Pharmacist Operations Advisor at A-Line Staffing Solutions include Pharmacy License; Access; Powerpoint; Visio; Excel; Word; Microsoft Teams; and Medicare Part D.

What category does the Pharmacist Operations Advisor role belong to?expand_more

Pharmacist Operations Advisor at A-Line Staffing Solutions is part of the scientific & qa job category on Recrutus.

Pharmacist Operations Advisor