Remote Clinical Pharmacist, Medicare Part D & MTM

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

Job summary

Alignment Health is seeking a Clinical Pharmacist I to join its remote pharmacy team. The role focuses on Part D coverage determinations, redeterminations, and MTM activities, applying CMS guidelines to deliver compliant reviews for Alignment Health Plan members.

Requires active pharmacist license in at least one U.S. state and at least 1 year in health plan or managed-care pharmacy, with weekend rotation and PST hours. A remote, full-production position in the United States.

Qualifications

• Bachelor’s degree in Pharmacy or related health science field.
• Active, unrestricted pharmacist license in at least one U.S. state.
• Preferred: Doctor of Pharmacy (PharmD), Master’s, or PhD.
• Minimum 1 year of health plan, PBM, or managed-care pharmacy experience.
• Bilingual English/Spanish is an asset.

Responsibilities

• Review Part D coverage decisions and appeals using CMS requirements.
• Conduct MTM reviews by telephone to identify drug therapy problems.
• Support Medicare Star Ratings and quality improvement initiatives.
• Maintain regulatory documentation for CMS timelines and CDAG.
• Collaborate with medical directors to aid clinical reviews.

Skills

Part D regulatory & formulary

Medication Therapy Management

Clinical decision-making

PBM systems

Regulatory compliance

Medical documentation & reporting

Data interpretation

Education

Bachelor's in Pharmacy or related health science

PharmD / Master / PhD (preferred)

Tools

PBM adjudication platforms

Pharmacy management software

Claims systems

Job description

Alignment Health is seeking a Clinical Pharmacist I to join its remote pharmacy team. The role focuses on Part D coverage determinations, redeterminations, and MTM activities, applying CMS guidelines to deliver compliant reviews for Alignment Health Plan members.

Requires active pharmacist license in at least one U.S. state and at least 1 year in health plan or managed-care pharmacy, with weekend rotation and PST hours. A remote, full-production position in the United States.