Founded in 1977 as the Senior Care Action Network, SCAN began with a simple but radical idea: that older adults deserve to stay healthy and independent. That belief was championed by a group of community activists we still honor today as the "12 Angry Seniors." Their mission continues to guide everything we do.
Today, SCAN is a nonprofit health organization serving more than 500,000 people across Arizona, California, Nevada, New Mexico, Texas, and Washington, with over $8 billion in annual revenue. With nearly five decades of experience, we have built a distinctive, values-driven platform dedicated to improving care for older adults.
Our work spans Medicare Advantage, fully integrated care models, primary care, care for the most medically and socially complex populations, and next-generation care delivery models. Across all of this, we are united by a shared commitment: combining compassion with discipline, innovation with stewardship, and growth with integrity.
At SCAN, we believe scale should strengthen-not dilute-our mission. We are building the future of care for older adults, grounded in purpose, accountability, and respect for the people and communities we serve.
This position will play an instrumental role in ensuring compliance and clinical appropriateness of Part D coverage determinations, appeals and grievances, and Part C organizational determinations for a senior-focused Medicare Advantage Plan. The Clinical Pharmacist will work alongside the Director to execute and ensure CMS compliant operations and strong star rating performance for these areas. In addition, the Clinical Pharmacist will support Interdisciplinary Care Team work, and complete medication-related clinical reviews to support the care management teams at SCAN. The Clinical Pharmacist will participate in other managed care responsibilities as assigned.
You Will
PBM (ESI) oversight of Part D coverage determinations, including review of clinical appropriateness, regulatory compliance, documentation quality, and timeliness issues
Internal IRR reviews of Part D appeals to ensure decisions are clinically sound, compliant with CMS requirements, and welldocumented prior to external escalation
MEIR Quality of Care (QOC) tasks, including review, documentation, and followup on potential access or processing issues
Coverage criteria maintenance and updates, including remediation from the mock Part D audit finding to correct nonformulary criteria containing questions unrelated to indication or formulary alternatives
Management of escalated and complex member issues requiring clinical review, crossteam coordination, and timely resolution
Support for ad hoc and timesensitive requests such as audit support, case lookbacks, issue investigations, and leadership inquiries
Exhibit professionalism and empathy in all interactions with members and provider partners.
Utilize department desktop procedures, workflows, job aids and training material.
Adhere to all quality, compliance, and regulatory standards.
We seek Rebels who are curious about AI and its power to transform how we operate and serve our members.
Actively support the achievement of SCAN's Vision and Goals.
Other duties as assigned.
Your Qualifications
Pharm. D. degree in process.
Current Intern Pharmacist License in California required.
Completion of residency/fellowship in Managed Care preferred.
Ability to work cross-functionally across the organization.
Excellent written/oral communication skills.
Self-starter who can work independently.
Ability to multi-task in a fast environment.
Ability to research, analyze, and problem solve.
Strong critical thinking skills.
What's in it for you?
This is a temporary opportunity for approximately 3- 6 months
Base Salary range: $20 per hour
Work Mode: Remote
Medical Benefits
Paid Sick Time
Excellent 401(k) Retirement Saving Plan
Robust employee recognition program
An opportunity to become part of a team that makes a difference to our members and our community every day!
We're always looking for talented people to join our team! Qualified applicants are encouraged to apply now!
At SCAN we believe that it is our business to improve the state of our world. Each of us has a responsibility to drive Equality in our communities and workplaces. We are committed to creating a workforce that reflects our community through inclusive programs and initiatives such as equal pay, employee resource groups, inclusive benefits, and more.
SCAN is proud to be an Equal Employment Opportunity and Affirmative Action workplace. Individuals seeking employment will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. A background check is required.
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Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)
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