Clinical Pharmacist

About the role

Deliver Clinical Excellence
Ensure Regulatory Compliance
Collaborate & Communicate
Support Formulary & Utilization Management
Drive Operational Excellence

Responsibilities

• Review and evaluate prior authorization requests for outpatient and specialty medications
• Conduct drug utilization reviews in compliance with regulatory standards
• Research and apply current clinical data and therapeutic guidelines
• Support appeals and grievance processes related to pharmacy benefit determinations
• Collaborate with PBM partners on formulary management and drug product updates
• Monitor and update formulary listings and PA criteria
• Analyze pharmacy trends and support cost-of-care initiatives
• Provide education to providers and internal stakeholders on pharmacy programs
• Auxiliary support during regulatory audits (DMHC, NCQA) and accreditation activities
• Participate in training, documentation, and process development initiatives
• Engage in system testing, validation, and operational readiness efforts
• Ensure timely case completion and cross-coverage support

Requirements

• Doctor of Pharmacy (PharmD) or equivalent required
• Active, unrestricted California Pharmacist license in good standing
• Minimum 4 years of pharmacy experience (retail, hospital, or mail order)
• 2+ years of managed care, PBM, or health plan experience preferred
• Experience with prior authorization review and utilization management
• Familiarity with formulary management and P&T committee processes preferred
• Proficiency in evaluating clinical literature and drug databases (e.g., UpToDate, DrugDex, NCCN)
• Strong computer skills including Microsoft Office and pharmacy systems

Qualifications

• Doctor of Pharmacy (PharmD) or equivalent required
• Active, unrestricted California Pharmacist license in good standing
• Minimum 4 years of pharmacy experience (retail, hospital, or mail order)
• 2+ years of managed care, PBM, or health plan experience preferred
• Experience with prior authorization review and utilization management
• Familiarity with formulary management and P&T committee processes preferred
• Proficiency in evaluating clinical literature and drug databases (e.g., UpToDate, DrugDex, NCCN)
• Strong computer skills including Microsoft Office and pharmacy systems

Benefits

Competitive compensation package including a salary range of $140,000 - $160,000 annually

Pay

$140,000 - $160,000 annually

Schedule

Full-Time | Exempt