Job Description

At Clover Health, we bring high-quality, affordable, and easy-to-understand healthcare plans to America’s seniors. We focus on preventive care and leverage data and technology from the Clover Assistant to empower physicians to make the best health recommendations based on our members’ complete health history—all with the lowest cost and the highest value.

The Clinical Pharmacist will work to support clinical initiatives and Medicare Part D regulatory requirements. You will solve unique medication-related issues for Clover members as a crucial part of our multidisciplinary clinical team. You will address a range of clinical needs from educating members on the importance of adherence to completing intensive medication management reviews and addressing barriers to drug therapy. This role also includes performing daily oversight activities of the Pharmacy Benefits Manager’s (PBM) delegated functions.

As a Clinical Pharmacist, you will:

• Provide clinical support to members and healthcare providers to enhance medication management and improve health outcomes.
• Maintain precise and comprehensive documentation of clinical interventions, patient interactions, and medication recommendations.
• Identify opportunities for cost-effective or lower-risk medication treatment plans.
• Support Pharmacy Benefits Manager (PBM) oversight and ensure compliance with CMS regulatory requirements related to Part D benefit administration.
• Contribute to quality improvement initiatives within case management and other clinical programs, enhancing member experience and medication adherence.
• Collaborate on process improvements, driving initiatives that elevate the member experience and support medication adherence.
• Assist with projects aimed at improving Medicare Part C & D Star Ratings, HEDIS, CAHPS, and other quality performance metrics.
• Analyze Part D/pharmacy data to evaluate program effectiveness, reporting findings to managers and internal/external stakeholders.
• Administer Clover Health’s Drug Formulary and support the Medication Therapy Management Program (MTMP).
• Participate in cross-functional meetings as a pharmacy/Part D subject matter expert (SME).
• Act as a resource for pharmacy program specialists and associate team members.
• Collaborate with leadership to allocate team resources effectively across day-to-day operations and key project initiatives.
• Continuously seek ways to improve processes and add value within the team.
• Perform other duties as required.

Success in this role looks like:

• First 90 Days: You have established a strong understanding of Clover’s clinical initiatives and Part D processes, and you are confidently performing medication reviews and contributing to PBM oversight activities.
• First 6 Months: You are autonomously managing a portfolio of clinical support activities, have successfully identified and implemented a process improvement that drives medication adherence, and are consistently providing high-quality counsel as a Part D subject matter expert.
• Future Success: You are a driving force behind improvements to Star Ratings and other quality metrics, leveraging data analysis to shape program strategy, and mentoring team members to elevate the team’s overall clinical and compliance expertise.

You should get in touch if:

• You have a Bachelor’s or Pharm-D degree and an active, unrestricted pharmacy license.
• You have knowledge of Medicare Part D regulations, including formulary management and Star Ratings.
• You have at least 2+ years of experience in managed care, retail, or mail-order pharmacy (geriatric or long-term care experience is a plus).
• You have at least 3+ years in pharmacy, managed care, or PBM settings.
• You have a strong clinical judgment, documentation skills, and a customer-focused mindset.
• You have a results-driven approach, attention to detail, and the ability to thrive in a remote setting.
• You are proficient with PC applications and excellent communication skills.

Benefits Overview : 

• Financial Well-Being : Our commitment to attracting and retaining top talent begins with a competitive base salary and equity opportunities. Additionally, we offer a performance-based bonus program, 401k matching, and regular compensation reviews to recognize and reward exceptional contributions.
• Physical Well-Being : We prioritize the health and well-being of our employees and their families by providing comprehensive medical, dental, and vision coverage. Your health matters to us, and we invest in ensuring you have access to quality healthcare.
• Mental Well-Being : We understand the importance of mental health in fostering productivity and maintaining work-life balance. To support this, we offer initiatives such as No-Meeting Fridays, monthly company holidays, access to mental health resources, and a generous flexible time-off policy. Additionally, we embrace a remote-first culture that supports collaboration and flexibility, allowing our team members to thrive from any location. 
• Professional Development : Developing internal talent is a priority for Clover. We offer learning programs, mentorship, professional development funding, and regular performance feedback and reviews.

Additional Perks:

• Employee Stock Purchase Plan (ESPP) offering discounted equity opportunities
• Reimbursement for office setup expenses
• Monthly cell phone & internet stipend
• Remote-first culture, enabling collaboration with global teams
• Paid parental leave for all new parents
• And much more!

About Clover: We are reinventing health insurance by combining the power of data with human empathy to keep our members healthier. We believe the healthcare system is broken, so we’ve created custom software and analytics to empower our clinical staff to intervene and provide personalized care to the people who need it most.

We always put our members first, and our success as a team is measured by the quality of life of the people we serve. Those who work at Clover are passionate and mission-driven individuals with diverse areas of expertise, working together to solve the most complicated problem in the world: healthcare.

From Clover’s inception, Diversity & Inclusion have always been key to our success. We are an Equal Opportunity Employer and our employees are people with different strengths, experiences, perspectives, opinions, and backgrounds, who share a passion for improving people’s lives. Diversity not only includes race and gender identity, but also age, disability status, veteran status, sexual orientation, religion and many other parts of one’s identity. All of our employee’s points of view are key to our success, and inclusion is everyone’s responsibility.

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Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. We are an E-Verify company.

For California, Colorado, New Jersey, New York, or Washington residents, a reasonable estimate of the base salary range for this role can be found below. For candidates residing in other geographic areas, the range will be adjusted based on location. Final pay is based on several factors including but not limited to internal equity, market data, and the applicant’s education, work experience, certifications, etc.

Colorado/Washington Pay Range

$98,000 – $134,000 USD

California/New Jersey/New York Pay Range

$108,000 – $149,000 USD

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