Remote Medicare Part D Pharmacist: Prior Auth & MTM

Alignment Health; San Francisco (CA); Remote; USD 113.000 - 170.000; Vollzeit

Zusammenfassung

Alignment Health seeks a Clinical Pharmacist I to join its remote pharmacy team, focusing on Medicare Part D coverage determinations, prior authorizations, MTM activities, and CMS compliance for AHP members.

The role requires active pharmacist licensure in at least one U.S. state, with 1+ year in health plan/PBM settings preferred. Schedule is Mon–Fri, 8:00 AM–5:00 PM PT, with weekend rotation; fully remote work.

Qualifikationen

• Required: Active pharmacist license in at least one U.S. state.
• Preferred: Experience in CDAG processes within Medicare Advantage.
• Preferred: MTM delivery and documentation in MTM platforms.
• Strong knowledge of CMS Part D coverage determinations and appeals.
• Experience with formulary management and utilization management.

Aufgaben

• Review Part D coverage determinations and appeals for CMS compliance.
• Conduct MTM reviews via telephone to identify drug therapy problems.
• Support quality initiatives aligned with Medicare Star Ratings and HEDIS measures.
• Maintain regulatory documentation and ensure CMS timelines compliance.
• Perform other duties and projects as assigned.

Kenntnisse

Part D regulatory & formulary

Medication Therapy Management (MTM)

Clinical decision-making

PBM systems

Regulatory compliance (CMS)

Documentation & reporting

Data interpretation & analytics

Ausbildung

Bachelor's degree in Pharmacy or related health science

PharmD / Doctor of Pharmacy

Tools

PBM adjudication platforms

Pharmacy management software

Claims systems

Jobbeschreibung

Alignment Health seeks a Clinical Pharmacist I to join its remote pharmacy team, focusing on Medicare Part D coverage determinations, prior authorizations, MTM activities, and CMS compliance for AHP members.

The role requires active pharmacist licensure in at least one U.S. state, with 1+ year in health plan/PBM settings preferred. Schedule is Mon–Fri, 8:00 AM–5:00 PM PT, with weekend rotation; fully remote work.