[Hiring] Clinical Pharmacist I @Alignment Health

Role Description

Alignment Health is seeking a Clinical Pharmacist I to join the pharmacy Team. A Clinical Pharmacist I is a remote, full-production managed care pharmacy role supporting Medicare Part D members. The position primarily supports Part D prior authorization and coverage determination/appeal reviews, along with Medication Therapy Management (MTM) activities. The pharmacist applies clinical judgement, plan benefits, and CMS requirements to deliver timely, compliant coverage decisions and medication reviews.

As a Clinical Pharmacist I, you will:

• Review coverage determinations and appeals to ensure clinical appropriateness and compliance with CMS regulations and plan benefits for Alignment Health Plan (AHP) members.
• Serve as a subject matter expert in Part D coverage determinations, redeterminations, and Part C organizational determinations.
• Conduct Medication Therapy Management (MTM) activities, including comprehensive medication reviews (CMRs) and targeted interventions, focusing on high-risk members to improve adherence, reduce high-risk medication utilization, and enhance overall quality of care for AHP members.
• Support additional managed care functions and projects as assigned.

Qualifications

• Minimum one year of health plan, PBM, or managed-care pharmacy experience.
• Highly Preferred: Medicare Part D prior authorization, coverage determination, appeals/redetermination, or pharmacy utilization management experience.
• Additional Relevant Experience: Medication Therapy Management, CMR/TMR, formulary exceptions, B vs. D determinations, quantity limits, step therapy, and other Medicare Part D pharmacy operations.

Requirements

• Experience: Minimum of 1 year of experience working at a health plan, Pharmacy Benefit Manager (PBM), or in a managed care pharmacy setting.
• Education: Bachelor's degree in Pharmacy or a related health science field.
• Preferred: Doctor of Pharmacy (PharmD), Master's degree, or PhD in Pharmacy. Equivalent combination of relevant education and demonstrated clinical experience will be considered.
• Licensure: Active and unrestricted pharmacist license in at least one U.S. state required.

Benefits

• Schedule: Monday–Friday, 8:00 AM–5:00 PM Pacific Time.
• Weekend Rotation: Rotational weekend coverage is required, currently approximately every 4–5 weeks, based on business needs and case volume.
• Location: Fully remote.

Essential Physical Functions

• The employee is regularly required to talk or hear.
• The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
• The employee frequently lifts and/or moves up to 10 pounds.
• Specific vision abilities required by this job include close vision and the ability to adjust focus.

Pay Range

$113,332.00 - $169,999.00. Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.