Clinical Pharmacist
Location: Orange, California US
Notice
Job Number: 1807
Workplace Type:
Position Title: Clinical Pharmacist
External Description:
Review Part D coverage determination and appeal requests and make clinical decisions in accordance with formulary benefits, guidelines, and CMS requirements
Research and respond to Part D grievances and inquiries, conducting outreach to prescribers, pharmacies, and members as needed
Monitor and oversee activities of Pharmacy Benefit Manager (i.e. benefit administration, clinical decision making, quality of customer service, compliance, etc.)
Support annual pharmacy benefit build activities and development of member materials
Manage Part D formulary and related activities
Develop formulary recommendations by assessing drug utilization trends, clinical guidelines, and drug spend
Conduct therapeutic class reviews and analyze pharmacy cost and utilization management trends
Perform Medication Therapy Management over the phone
Attend interdisciplinary clinical rounds to provide pharmacy recommendations and improve patient health outcomes
Participate in plan and regulatory reporting and audits
Support various Pharmacy Department operations, programs, and initiatives as needed
Perform other related duties and projects assigned
Requirements:
- Pharm. D. or Bachelor’s degree in pharmacy
- Active pharmacist license in good standing
- Minimum of 2 years of experience at a health plan and/or PBM
- Previous work experience with Medicare Part D
- Previous work experience in CDAG (coverage determinations, appeals, and grievances)
- Previous work experience in Part D formulary management preferred
- Previous work experience in Medication Therapy Management preferred
City: Orange
State: California
Location City: Orange
Location State: California
Community / Marketing Title: Clinical Pharmacist
Company Profile:
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.
EEO Employer Verbiage:
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.
*DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health’s talent acquisition team, please email [email protected].