Clinical Pharmacy Specialist (Medicare)

Location: Remote within the United States, including Tennessee and Chattanooga. Schedule: Monday–Friday, 8 AM–6 PM EST, with rotating nights, weekends, holidays, and on-call coverage as needed.

Company

hirify.global provides health insurance and pharmacy benefit services.

What you will do

• Support Medicare and D-SNP pharmacy coverage reviews, appeals, and coverage determinations.
• Enter authorizations and test claims into the pharmacy benefit system to support accurate claim adjudication.
• Handle calls from providers, members, and member representatives to complete coverage determinations and appeals.
• Monitor emails and FACETs inquiries related to pharmacy reviews, appeals, and claims issues.
• Review daily pharmacy reports and assist with departmental audits and quality improvement activities.

Requirements

• High school diploma or equivalent.
• At least 2 years of pharmacy experience.
• National Pharmacy Technician Certification Board certification (PTCB).
• Proficiency in Microsoft Outlook, Word, Excel, and PowerPoint.
• Knowledge of medical and pharmacy terminology, with strong communication, organization, decision-making, and problem-solving skills.
• Ability to work independently with minimal supervision and manage multiple projects.

Culture & Benefits

• Remote work environment with tools and resources provided for success.
• Opportunities to develop specialized knowledge in pharmacy coverage review.
• Culture focused on innovation, growth, creativity, and continuous learning.
• Collaboration with pharmacists, healthcare providers, members, and internal pharmacy teams.