Remote Clinical Pharmacist I: Medicare Part D & MTM

Alignment Healthcare USA, LLC; Orange (CA); Remote; USD 113,000 - 170,000; Full time

Job summary

Alignment Health is seeking a Clinical Pharmacist I for a fully remote, production-driven role supporting Medicare Part D. You will review coverage determinations and appeals, conduct MTM activities, and support quality initiatives to improve member outcomes.

The schedule is Monday–Friday, 8:00 AM–5:00 PM PT with rotational weekend coverage. Requirements include an active pharmacist license in at least one state and 1+ year in health plan, PBM, or managed-care pharmacy.

Qualifications

• Bachelor's degree in Pharmacy or equivalent required.
• Active, unrestricted pharmacist license in at least one U.S. state.
• Experience in health plan, PBM, or managed-care setting recommended.

Responsibilities

• Review Part D coverage determinations and appeals to ensure CMS compliance and plan benefits.
• Deliver MTM services including comprehensive medication reviews (CMRs) by telephone.
• Perform COA-MDR to support Stars quality measures and senior care outcomes.
• Collaborate with medical directors to obtain clinical information for reviews.
• Participate in Medicare Star Ratings, HEDIS, and quality improvement initiatives.
• Maintain accurate documentation of reviews, determinations, and communications.

Skills

Part D Formulary

MTM

Clinical Decision-Making

PBM Systems

Regulatory Compliance

Medical Documentation

Data Analytics

Education

Bachelor's in Pharmacy

PharmD/Advanced degree (preferred)

Tools

PBM Platforms

Pharmacy Management Software

Job description

Alignment Health is seeking a Clinical Pharmacist I for a fully remote, production-driven role supporting Medicare Part D. You will review coverage determinations and appeals, conduct MTM activities, and support quality initiatives to improve member outcomes.

The schedule is Monday–Friday, 8:00 AM–5:00 PM PT with rotational weekend coverage. Requirements include an active pharmacist license in at least one state and 1+ year in health plan, PBM, or managed-care pharmacy.