Alignment Health
501 - 1000 employees
Founded 2013
⚕️ Healthcare Insurance
💰 $135M Series C on 2020-03
Healthcare Insurance • Insurance • Healthcare
Alignment Health is dedicated to providing comprehensive care for Medicare members, emphasizing the needs of seniors, the chronically ill, and those who are frail. With a mission to transform senior healthcare, Alignment Health leverages a tailored care model and advanced technology to deliver high-quality, low-cost healthcare services. Their 24/7 concierge care team collaborates with trusted local providers to ensure that every member receives personalized care, reflecting the company's commitment to treating all members as valued family members.
Clinical Pharmacist I
🔥 0 minutes ago
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Alignment Health
501 - 1000 employees
Founded 2013
⚕️ Healthcare Insurance
💰 $135M Series C on 2020-03
Healthcare Insurance • Insurance • Healthcare
Alignment Health is dedicated to providing comprehensive care for Medicare members, emphasizing the needs of seniors, the chronically ill, and those who are frail. With a mission to transform senior healthcare, Alignment Health leverages a tailored care model and advanced technology to deliver high-quality, low-cost healthcare services. Their 24/7 concierge care team collaborates with trusted local providers to ensure that every member receives personalized care, reflecting the company's commitment to treating all members as valued family members.
📋 Description
• Review and render Part D coverage determination and appeal requests. • Conduct comprehensive medication reviews via telephone for members enrolled in the MTM program. • Participate in pharmacy quality improvement projects aligned with Medicare Star Ratings. • Maintain appropriate records of all clinical reviews, coverage determinations, and consultations in accordance with CMS timelines.
🎯 Requirements
• Minimum of 1 year of experience working at a health plan, Pharmacy Benefit Manager (PBM), or in a managed care pharmacy setting. • Bachelor's degree in Pharmacy or a related health science field. • Active and unrestricted Pharmacist license in the applicable state(s). • In-depth understanding of CMS Medicare Part D coverage determination and appeal processes. • Proficiency in conducting CMR and TMR reviews; familiarity with MTM platforms and documentation requirements.
🏖️ Benefits
• Health insurance • Flexible work arrangements • Professional development
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