Location: Orange, California US
Job Number: 1807
Position Title: Clinical Pharmacist
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
- 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
Location City: Orange
Location State: California
Community / Marketing Title: Clinical Pharmacist
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.
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 firstname.lastname@example.org.