Alignment Healthcare is a population health management company dedicated to changing the way health care is delivered in the United States. We are a fast-growing, highly dynamic organization that isn’t content with the status quo. We are looking for dedicated, innovative individuals who thrive in a fast-paced environment to join our team and help us carry out our vision - that is, to lead a movement that transformationally improves health care.

Join us today and we will give you every opportunity to succeed.

Clinical Pharmacist (AHC TEMP)

Notice

This position is no longer open.

Job Number: 1121

Position Title: Clinical Pharmacist

External Description:

 

Manage the implementation and maintenance of formularies on a weekly basis and ensure that adjudication and related publications reflect the latest changes

Analyze pharmacy cost of care trends and develop appropriate use protocols and guidelines for cost containment and utilization management

Review Part D coverage determination and redetemination requests and make clinical decisions in accordance with formulary benefits, guidelines, and CMS requirements

Conduct MTM telephonic comprehensive medication reviews

Research and respond to Part D grievances, conducting outreach to prescribers, pharmacies, and members as needed

Support annual pharmacy benefit build activities and development of member materials 

Monitor and oversee activities of Pharmacy Benefit Manager (i.e. benefit administration, clinical decision making, quality of customer service, compliance, etc.)

Participate in plan and regulatory reporting and audits

Create various policy and procedures

Develop and execute provider and member campaigns focused on improving clinically oriented HEDIS/CMS STARS and HOS scores, as well as customer satisfaction oriented CAHPS survey results

Participate in multi-disciplinary clinical meetings and help identify and close gaps in care

Support various Pharmacy Department operations, programs, and initiatives as needed

 

Minimum requirements:

  • Minimum of 2 years pharmacy experience at a health plan and/or PBM
  • Knowledge of Medicare Part D
  • Previous work experience in health plan formulary management
  • Previous work experience in CDAG (coverage determinations, appeals, and grievances)
  • Previous work experience in making telephonic MTM calls
  •  

Preferred:

  • Experience with Part D STARs and HEDIS
  • Experience with Part B/Medical Pharmacy Specialty Management
  • Proficiency in Excel and/or Access

City: Orange

State: California

Location City: Orange

Location State: California

Community / Marketing Title: Clinical Pharmacist (AHC TEMP)

Company Profile:

Who is Alignment Healthcare?

  • Socially responsible
  • Technologically enabled
  • Concierge care
  • Transformation
  • Servant leadership

We are dedicated to transforming the complex and confusing process of medical treatment in the United States so that every link in the health care continuum becomes more efficient, productive, and effective. We built a team of people who want to make a difference. Come join the team that is changing health care one person at a time.

We believe that great work comes from people who are inspired to be their best. We invite you to explore our wide variety of roles based on your unique experience.

EEO Employer Verbiage:

Alignment Healthcare, LLC is proud to practice Equal Employment Opportunity and Affirmative Action. We are looking for diversity in qualified candidates for employment: Minority/Female/Disable/Protected Veteran.

If you require any reasonable accommodation under the Americans with Disabilities Act (ADA) in completing the online application, interviewing, completing any pre-employment testing or otherwise participating in the employee selection process, please contact careers@ahcusa.com.

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