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.

The Clinical Pharmacist at Alignment health Plan is involved in a wide range of projects throughout the year. Projects include, performs Part D coverage determination and appeal, responds to internal pharmacy questions, assists audits, reviews member materials, tests, and builds benefits among others.

GENERAL DUTIES/RESPONSIBILITIES:
1. Reviews Part D coverage determination and appeal requests and make clinical decisions in accordance with formulary benefits, guidelines, and CMS requirements
2. Researches and responds to Part D grievances and inquiries, conducting outreach to prescribers, pharmacies, and members as needed
3. Monitors and oversees activities of Pharmacy Benefit Manager (i.e. benefit administration, clinical decision making, quality of customer service, compliance, etc.)
4. Supports annual pharmacy benefit build activities and development of member materials
5. Manages Part D formulary and related activities
6. Develops formulary recommendations by assessing drug utilization trends, clinical guidelines, and drug spend
7. Conducts therapeutic class reviews and analyze pharmacy cost and utilization management trends
8. Performs Medication Therapy Management over the phone
9. Attends interdisciplinary clinical rounds to provide pharmacy recommendations and improve patient health outcomes
10. Participates in plan and regulatory reporting and audits
11. Supports various Pharmacy Department operations, programs, and initiatives as needed
12. Performs other related duties and projects assigned

Minimum Requirements:

Standard work schedule: Monday through Friday, 8 AM - 5 PM PST, with availability for rotational weekend shifts as needed.
Occasional onsite travel to the corporate office in Orange, CA may be required. Candidates should be prepared to travel up to 10% of the time to meet business needs

Experience:
• Required: Minimum of three years of experience at a health plan and/or PBM. Three years of work experience with Medicare Part D. Three years' experience in CDAG (coverage determinations, appeals, and grievances)
• Preferred: Previous work experience in Part D formulary management. Previous work experience in Medication Therapy Management.

Education:
• Required: Bachelors Degree, Masters Degree or PhD in Pharmacy.
• Preferred: Pharm. D.

Specialized Skills Required:

Ability to communicate positively, professionally and effectively with others; provide leadership, teach and collaborate with others.
Effective written and oral communication skills; ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors;
Mathematical Skills: Ability to perform mathematical calculations and calculate simple statistics correctly
Reasoning Skills: Ability to prioritize multiple tasks; advanced problem-solving; ability to use advanced reasoning to define problems, collect data, establish facts, draw valid conclusions, and design, implement and manage appropriate resolution.
Problem-Solving Skills: Effective problem solving, organizational and time management skills and ability to work in a fast-paced environment.
Report Analysis Skills: Comprehend and analyze statistical reports.

Licensure:
• Required: Active pharmacist license in good standing

Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Essential Physical Functions:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1 While performing the duties of this job, the employee is regularly required to talk or hear.

2 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.

3 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: $126,422.00 - $189,634.00
Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.

Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.

*DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health's talent acquisition team, please email careers@ahcusa.com.

Alignment Healthcare

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Clinical Pharmacist