Clinical Pharmacist I – Remote

About the role

Alignment Health is seeking a Clinical Pharmacist I to work remotely supporting senior members of the Alignment Health Plan. The role focuses on reviewing Part D coverage determinations, conducting medication therapy management, and ensuring compliance with CMS regulations.

Key responsibilities

• Review and render Part D coverage determinations and appeals, applying clinical judgment and CMS requirements.
• Collaborate with medical directors to provide clinical information for guideline‑based reviews.
• Conduct comprehensive medication reviews (CMRs) via telephone for MTM program participants, identifying drug therapy problems and creating medication action plans.
• Perform the Care for Older Adults Medication Review (COA‑MDR) to support Star quality measures.
• Participate in pharmacy quality improvement projects linked to Medicare Star Ratings and HEDIS metrics.
• Maintain accurate documentation of all clinical reviews, determinations, and consultations in line with CMS timelines.

Required profile

• Active pharmacist license.
• Experience with Medicare Part D coverage determinations and appeals.
• Familiarity with CMS regulations, including CDAG guidelines.
• Ability to conduct medication therapy management for high‑risk and senior populations.

Required skills

• Medicare Part D coverage determination
• CMS regulations compliance
• Medication Therapy Management (MTM)
• Comprehensive medication reviews (CMR)
• Care for Older Adults Medication Review (COA‑MDR)