Remote Clinical Pharmacist for Medicare Part D & MTM

Alignment Health; Oregon; Hybrid; USD 113,000 - 170,000; Full time

Job summary

Alignment Health is seeking a Clinical Pharmacist I to join the pharmacy team. This fully remote role supports Medicare Part D, focusing on prior authorization, coverage determinations, and MTM activities for Alignment Health Plan members.

The position requires a licensed pharmacist in at least one U.S. state and 1+ year of health plan or managed-care experience, with Part D operations and MTM experience highly preferred.

Qualifications

• Bachelor's degree in Pharmacy required; PharmD preferred.
• Active and unrestricted pharmacist license in at least one U.S. state.
• Minimum 1 year of health plan or managed-care pharmacy experience.

Responsibilities

• Review Part D coverage determinations and appeals for CMS compliance.
• Conduct MTM reviews (CMR/TMR) to improve adherence and outcomes.
• Participate in quality initiatives aligned with Stars/HEDIS and CMS standards.
• Maintain documentation per CMS timelines and CDAG guidelines.

Skills

Health plan experience

PBM experience

Managed care pharmacy

Clinical decision-making

Education

Bachelor's degree in Pharmacy

Doctor of Pharmacy (PharmD)

Tools

PBM platforms

Job description

Alignment Health is seeking a Clinical Pharmacist I to join the pharmacy team. This fully remote role supports Medicare Part D, focusing on prior authorization, coverage determinations, and MTM activities for Alignment Health Plan members.

The position requires a licensed pharmacist in at least one U.S. state and 1+ year of health plan or managed-care experience, with Part D operations and MTM experience highly preferred.