Clinical Pharmacist I - Medicare Part D / Prior Auth (Remote | M-F, 8am-5pm Paci

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first.We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together. 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. This role serves as a subject matter expert in Part D coverage determinations, redeterminations, and Part C organizational determinations. In addition, the Clinical Pharmacist I conducts Medication Therapy Management (MTM) activities, including comprehensive medication reviews (CMRs) and targeted interventions, with a focus on high-risk members to improve adherence, reduce high-risk medication utilization, and enhance overall quality of care for AHP members. The Clinical Pharmacist I supports additional managed care functions and projects as assigned. What You Should Know - 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 - Licensure: Active, unrestricted pharmacist license in at least one U.S. state required - Required Experience: 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...

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