Clinical Pharmacist

Job Number6809Workplace Type:Fully RemoteRemote-US,California

By leveraging our world-class technology platform, innovative care delivery models, deep physician partnerships and our serving heart culture, Alignment Health is revolutionizing health care for seniors! From member experience professionals and clinicians, to data scientists and operations leaders, we have built a talented and passionate team that is deeply committed to our mission of transforming health care for the seniors we serve. Ready to join us?

At Alignment, delivering exceptional care to seniors starts with ensuring an exceptional experience for our over 1,300 employees. At the center of our employee experience is a culture where employees at all levels and across all teams are encouraged to share their unique ideas and perspectives. After all, when you can bring your authentic self to work, whether that’s in a clinical setting, our corporate office or a home office, creativity and innovation flourish! Another important part of the Alignment culture is a belief in continuous learning and growth. As a result, in this fast-growing company, you will find ample support to grow your skills and your career – with us.

Position Description:

• Review Part D coverage determination and appeal requests, making clinical decisions based on formulary benefits, guidelines, and CMS requirements.
• Perform computer-based tasks and make phone calls to providers when clinical information is needed.
• Consult with physicians and providers on questions and interpretations of clinical guideline criteria and coverage determinations.
• May conduct comprehensive medication reviews over the phone for members enrolled in the Medication Therapy Management program
• May participate in pharmacy quality initiatives and perform the Care for Older Adults Medication Review (COA-MDR).
• Support various Pharmacy Department operations, programs, and initiatives as needed.
• Perform other related duties and projects as assigned.
• Maintain productive working relationships with team members, internal and external customers, and management.

Requirements:

• BS in Pharmacy or Pharm D degree
• Pharmacist license in good standing.
• Minimum of 1 year of experience in a health plan and/or PBM.
• Previous work experience with Medicare Part D.
• Previous experience in CDAG (coverage determinations, appeals, and grievances).
• Previous work experience in Medication Therapy Management preferred
• Ability to work an 8-hour shift within the hours of 8:00am to 9:00pm Monday - Friday, including Saturdays (7:00am - 6:00pm) by rotation.
• Intermediate or higher proficiency in Microsoft Office Suite, including Word, Excel, and PowerPoint.
• Ability to work independently as well as part of a team.

Pay Range: $130,000 - $135,200 annually.

Please note: All clinical positions are contingent upon successful engagement with Alignment Health’s COVID-19 Vaccination program (fully vaccinated with documented proof or approved exception/deferral).

Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.

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