Remote Clinical Pharmacist – Medicare Part D & Prior Auth

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

Job summary

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

You will conduct comprehensive MTMs, including CMRs and targeted interventions for high-risk members, aiming to improve adherence and quality of care. A valid U.S.

Qualifications

• Bachelor’s degree in Pharmacy or related health science field required.
• Active pharmacist license in at least one U.S. state required.
• Minimum 1 year of health plan, PBM, or managed-care pharmacy experience required.
• Experience with Medicare Part D operations: prior authorization, coverage determinations, appeals preferred.

Responsibilities

• Drive accurate and timely Part D coverage decisions.
• Deliver MTM services including CMRs and COA-MDR.
• Advance pharmacy quality and compliance initiatives.
• Ensure regulatory and documentation integrity.
• Other duties as assigned.

Skills

Part D regulatory knowledge

Medication Therapy Management (MTM)

Clinical decision-making

PBM systems experience

Regulatory compliance

Medical documentation & reporting

Data interpretation

Education

Bachelor’s degree in Pharmacy or related health science

PharmD/Doctor of Pharmacy preferred

Masters/PhD in Pharmacy (if applicable)

Tools

PBM adjudication platforms

Pharmacy management software

Job description

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

You will conduct comprehensive MTMs, including CMRs and targeted interventions for high-risk members, aiming to improve adherence and quality of care. A valid U.S.