Remote Clinical Pharmacist - Part D & Prior Auth

Alignment Health; California City (CA); À distance; USD 113 000 - 170 000; Plein temps

Résumé du poste

Alignment Health is seeking a Clinical Pharmacist I to join our remote pharmacy team. The role focuses on Part D coverage determinations, MTM activities, and regulatory compliance within a managed care setting for Medicare members.

The position emphasizes high-quality, timely decisions, medication reviews, and adherence to CMS guidelines. It requires at least 1 year of health plan or PBM experience and is fully remote with a Monday–Friday schedule and weekend rotation as needed.

Qualifications

• Required: Minimum of 1 year of health plan, PBM, or managed-care pharmacy experience.
• Preferred: Medicare Part D operations, formulary management, or utilization management experience.
• Bilingual (English/Spanish) is a plus.

Responsabilités

• Drive Accurate and Timely Part D Coverage Decisions by reviewing and rendering Part D determinations and appeals.
• Deliver Medication Therapy Management Services via telephone for MTM program members and support Stars quality measures.
• Advance Pharmacy Quality and Compliance Initiatives aligned with Medicare Star Ratings and HEDIS measures.
• Ensure Regulatory and Documentation Integrity per CMS timelines and CMS/CDAG guidelines.
• Other duties and projects as assigned.

Connaissances

Part D Regulatory Knowledge

Medication Therapy Management

Clinical Decision-Making

Regulatory Compliance

Data Analysis

PBM Systems

Formation

Bachelor’s degree in Pharmacy

Doctor of Pharmacy (PharmD) preferred

Outils

PBM Adjudication Platforms

Pharmacy Management Software

Claims Systems

Description du poste

Alignment Health is seeking a Clinical Pharmacist I to join our remote pharmacy team. The role focuses on Part D coverage determinations, MTM activities, and regulatory compliance within a managed care setting for Medicare members.

The position emphasizes high-quality, timely decisions, medication reviews, and adherence to CMS guidelines. It requires at least 1 year of health plan or PBM experience and is fully remote with a Monday–Friday schedule and weekend rotation as needed.