Remote Clinical Pharmacist - Medicare Part D & Prior Auth

Alignment Health; Sacramento (CA); Remote; USD 113,000 - 170,000; Full time

Benefits offered by this job

Fully remote

Job summary

Alignment Health seeks a Clinical Pharmacist I to join a remote, full-production managed care pharmacy team. The role centers on Medicare Part D coverage determinations, prior authorizations, and MTM activities.

You will apply CMS guidelines and plan benefits to render timely, compliant decisions for seniors enrolled in Part D. Responsibilities include conducting MTM reviews by phone, optimizing regimens for complex patients, and supporting Stars quality measures while ensuring regulatory

Qualifications

• Minimum 1 year of health plan or managed-care pharmacy experience.
• Experience with Medicare Part D operations is highly preferred.
• Active pharmacist license in at least one U.S. state.

Responsibilities

• Review Part D coverage determinations and appeals per CMS guidelines.
• Conduct MTM reviews via telephone and develop medication action plans.
• Support quality improvement initiatives and regulatory compliance.
• Maintain documentation for CMS timelines and CDAG processes.
• Collaborate with medical directors to provide clinical information.

Skills

Regulatory compliance

Clinical decision making

MTM

Data interpretation

Bilingual English/Spanish

Education

Bachelor's degree in Pharmacy

PharmD/Advanced degree preferred

Tools

PBM systems

Pharmacy management software

Job description

Alignment Health seeks a Clinical Pharmacist I to join a remote, full-production managed care pharmacy team. The role centers on Medicare Part D coverage determinations, prior authorizations, and MTM activities.

You will apply CMS guidelines and plan benefits to render timely, compliant decisions for seniors enrolled in Part D. Responsibilities include conducting MTM reviews by phone, optimizing regimens for complex patients, and supporting Stars quality measures while ensuring regulatory