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Clinical Pharmacist
2 months ago
Alignment Healthcare is seeking a highly skilled Clinical Pharmacist to join our team. As a Clinical Pharmacist, you will play a critical role in ensuring that our members receive high-quality care and services.
Key Responsibilities- Review Part D coverage determination and appeal requests, making clinical decisions based on formulary benefits, guidelines, and CMS requirements.
- Perform computer-based tasks and communicate with providers to obtain clinical information.
- Consult with physicians and providers on questions and interpretations of clinical guideline criteria and coverage determinations.
- Conduct comprehensive medication reviews over the phone for members enrolled in the Medication Therapy Management program.
- 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.
- Maintain productive working relationships with team members, internal and external customers, and management.
- 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
Alignment Healthcare offers a competitive salary range of $130,000 - $135,200 annually, as well as a comprehensive benefits package and opportunities for professional growth and development.
