Clinical Pharmacist (Temporary)

Job Number: 1330

Workplace Type:

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 (Temporary)

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].