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

Location: Orange, California US

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Job Number: 1807

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:

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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