Remote Clinical Pharmacist I - Part D & MTM Expert

E2E Alignment Healthcare USA, LLC; California; Hybrid; USD 113,000 - 170,000; Full time

Benefits offered by this job

Remote work

Job summary

Alignment Health is seeking a Clinical Pharmacist I to join the remote pharmacy team. This full-time role supports Medicare Part D operations including prior authorizations, coverage determinations, and MTM activities, ensuring CMS compliance and high-quality patient care for AHP members.

The position requires an active pharmacist license in at least one U.S. state, with a minimum of one year in health plan, PBM, or managed-care pharmacy experience. Weekend rotations and PST hours apply.

Qualifications

• 1 year of health plan, PBM, or managed-care pharmacy experience.
• Active pharmacist license in at least one U.S. state.
• Experience with Part D coverage determinations and appeals is preferred.

Responsibilities

• Review Part D coverage determinations and appeals per CMS requirements.
• Conduct MTM via telephone and develop medication action plans.
• Support Medicare Star Ratings, quality initiatives and regulatory compliance.
• Maintain documentation of all reviews and communications per CMS timelines.
• Perform other duties and projects as assigned.

Skills

Pharmacist license

Medicare Part D

MTM reviews

Clinical decision-making

Education

Bachelor's degree in Pharmacy

PharmD preferred

Tools

PBM systems

Job description

Alignment Health is seeking a Clinical Pharmacist I to join the remote pharmacy team. This full-time role supports Medicare Part D operations including prior authorizations, coverage determinations, and MTM activities, ensuring CMS compliance and high-quality patient care for AHP members.

The position requires an active pharmacist license in at least one U.S. state, with a minimum of one year in health plan, PBM, or managed-care pharmacy experience. Weekend rotations and PST hours apply.