To support the Centers for Medicare & Medicaid Services (CMS), the PRN Pharmacist Reviewer will evaluate prior authorization and step therapy criteria for Medicare Part D plan sponsors, ensuring compliance with CMS guidelines, in a fully remote, seasonal role requiring approximately 20 hours per week during peak periods.
Key responsibilities: Reviews sponsor-submitted prior authorization and step therapy criteria for compliance with CMS guidance Evaluates clinical appropriateness of criteria fields and ensures consistency with FDA-approved labeling and treatment guidelines Writes transparent and specific comments for plan sponsors on any deficiencies identified in the submitted criteria Required qualifications: Doctor of Pharmacy degree from an accredited college or university Current, active, unrestricted license to practice pharmacy in the United States Minimum five years of experience in clinical pharmacy, formulary management, or Medicare Part D Experience developing or reviewing prior authorization and step therapy criteria for Part D plan sponsors preferred Advanced knowledge of Medicare Part D coverage requirements and utilization management programs