Remote Clinical Pharmacist for Medicare Part D & MTM

Alignment Healthcare; United States; Remote; USD 113,000 - 170,000; Full time

Job summary

Alignment Health is seeking a Clinical Pharmacist I to join the pharmacy team in a fully remote setting, supporting Medicare Part D operations. This role emphasizes Part D coverage determinations, MTM activities, and CMS compliance to deliver timely, compliant decisions for Alignment Health Plan members.

The position requires active licensure in at least one U.S. state, one year of managed-care pharmacy experience, and a Monday–Friday schedule with weekend rotation, providing opportunities to

Qualifications

• 1 year of health plan, PBM, or managed-care pharmacy experience required.
• Preferred: Part D prior authorization, coverage determinations, appeals/redeterminations.
• Active, unrestricted pharmacist license in at least one U.S. state required.
• Experience with MTM platforms and documentation is desirable.

Responsibilities

• Review Part D coverage determinations and appeals to render compliant decisions.
• Conduct Medication Therapy Management services, including comprehensive medication reviews via telephone.
• Advance pharmacy quality and compliance initiatives aligned with Medicare Star Ratings & HEDIS.
• Maintain regulatory documentation in CMS timelines and CDAG guidelines.
• Support additional managed care functions as assigned.

Skills

Part D Regulatory & Formulary Knowl.

Medication Therapy Management

Clinical Decision-Making & Evidence

PBM Systems & Pharmacy Mgmt

Healthcare Regulatory Compliance

Medical Documentation & Reporting

Data Interpretation & Analytics

Education

Bachelor's degree in Pharmacy or related health science

Doctor of Pharmacy (PharmD) or higher

Tools

PBM software

Job description

Alignment Health is seeking a Clinical Pharmacist I to join the pharmacy team in a fully remote setting, supporting Medicare Part D operations. This role emphasizes Part D coverage determinations, MTM activities, and CMS compliance to deliver timely, compliant decisions for Alignment Health Plan members.

The position requires active licensure in at least one U.S. state, one year of managed-care pharmacy experience, and a Monday–Friday schedule with weekend rotation, providing opportunities to