Alignment Healthcare pismo beach , CA 93449
Posted 7 days ago
Position Description:
Review Part D coverage determination and appeal requests, making clinical decisions based on formulary benefits, guidelines, and CMS requirements.
Perform computer-based tasks and make phone calls to providers when clinical information is needed.
Consult with physicians and providers on questions and interpretations of clinical guideline criteria and coverage determinations.
May conduct comprehensive medication reviews over the phone for members enrolled in the Medication Therapy Management program
May participate in pharmacy quality initiatives and perform the Care for Older Adults Medication Review (COA-MDR).
Support various Pharmacy Department operations, programs, and initiatives as needed.
Perform other related duties and projects as assigned.
Maintain productive working relationships with team members, internal and external customers, and management.
Requirements:
BS in Pharmacy or Pharm D degree
Pharmacist license in good standing.
Minimum of 1 year of experience in a health plan and/or PBM.
Previous work experience with Medicare Part D.
Previous experience in CDAG (coverage determinations, appeals, and grievances).
Previous work experience in Medication Therapy Management preferred
Ability to work an 8-hour shift within the hours of 8:00am to 9:00pm Monday
Friday, including Saturdays (7:00am
6:00pm) by rotation.
Intermediate or higher proficiency in Microsoft Office Suite, including Word, Excel, and PowerPoint.
Ability to work independently as well as part of a team.
Pay Range: $130,000 - $135,200 annually.
Alignment Healthcare