Clinical Pharmacist I - Medicare Part D / Prior Auth (Remote | M-F, 8am-5pm Paci
Alignment Health · United States · US
Utilization Review
Remote
physician
Pharmacist
Demand80
Career growth70
Healthcare fit78
Remote potential100
Salary band
USD 113k – 170k
5-year outlook
Likely stable managed care pharmacy compensation with limited public salary detail; growth depends on Medicare Part D, PBM, and utilization management demand rather than direct patient-care expansion.
Clinical license
Required
Applicant reach
narrow
Seniority
entry
Employment type
full-time
Date found
2026-10-23
Intelligence details
Flexible work details
- Engagement type
- Permanent
- Hours
- Full-time
- Eligible countries
- United States
- License jurisdiction
- US
- Profession fit
- physician, Pharmacist
- Rate period
- Annual
Listing via Himalayas.
Eligibility, licensing, and location restrictions can change. Always confirm details on the source posting before applying.
Why this is worth applying to
Worth applying for licensed pharmacists with managed care/PBM or Part D prior authorization experience who want a fully remote utilization-review role. Less suitable for clinicians without pharmacy licensure or managed care exposure.
Who should apply
Licensed pharmacists with health plan, PBM, or managed-care experience, especially those with Medicare Part D prior authorization, coverage determination, appeals, MTM/CMR, or pharmacy utilization management backgrounds.
CV angle
Frame the CV around active pharmacist licensure, managed care/PBM experience, Part D coverage determinations and appeals, CMS compliance, MTM/CMR, formulary exceptions, step therapy, quantity limits, and quality/Star/HEDIS projects. Quantify case volume, turnaround times, and audit/compliance outcomes only where real.
Skills to highlight
- Medicare Part D
- Prior authorization
- Coverage determinations and appeals
- Medication Therapy Management (MTM)
- Comprehensive medication reviews (CMRs)
- CMS regulations
- Formulary exceptions/step therapy/quantity limits
- Star Ratings/HEDIS quality initiatives
Role summary
Remote managed care pharmacist role reviewing Medicare Part D prior authorizations, coverage determinations, appeals, and MTM/CMR activities for senior members, applying CMS rules and plan benefits to support compliant, timely decisions.
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