Clinical Pharmacist (AHC TEMP)
Location: Orange, California US
Job Number: 1121
Position Title: Clinical Pharmacist
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 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
- Experience with Part D STARs and HEDIS
- Experience with Part B/Medical Pharmacy Specialty Management
- Proficiency in Excel and/or Access
Location City: Orange
Location State: California
Community / Marketing Title: Clinical Pharmacist (AHC TEMP)
Who is Alignment Healthcare?
- Socially responsible
- Technologically enabled
- Concierge care
- 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.
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