Y AS-NEEDED - Clinical Pharmacist

We are a mission-driven, community-based organization dedicated to serving member health with excellence and dignity, respecting the value and needs of each person.

About the role

Join our Pharmacy Management team as an As-Needed Clinical Pharmacist, shaping the future of healthcare. This position is integral to advancing pharmacy quality initiatives and clinical programs within Medi-Cal, Medicare, and Covered California. You will research, develop, and update drug utilization management strategies, promote clinically appropriate prescribing practices, and collaborate with plan members, prescribers, pharmacies, and the Pharmacy Benefit Manager (PBM).

This role is approved for full telework, requiring you to work within the State of California only. If partial telework is approved, you must also come into the main office in Orange, CA, at least two days per week.

Responsibilities

• Participate in a mission-driven culture focused on high-quality performance, customer service, consistency, dignity, and accountability.
• Assist the team in carrying out department responsibilities and collaborate with others to support short- and long-term goals.
• Generate and analyze claims and utilization reports to track drug utilization trends and identify potential targeted utilization management activities.
• Develop and update drug utilization criteria.
• Maintain contacts and relationships with providers key to successful interaction and intervention activities.
• Participate in medication review, disease state management, and clinical quality improvement programs, including Stars, HEDIS, Medication Therapy Management (MTM), interdisciplinary care teams, and drug utilization reviews.
• Assist in preparing drug monographs and utilization reports for the Pharmacy and Therapeutics committee.
• Review drug prior authorization and appeals requests using clinical and regulatory guidelines.
• Adhere to regulatory compliance, quality guidelines, and CalOptima Health’s policies and procedures.
• Update pharmacy policies and recommend new policies and procedures as needed.
• Work with management to develop and implement target drug utilization intervention programs and other DUR/DUE activities.
• Collaborate with the Director and Medical Management team on data integration, disease management, and outcomes projects.
• Review members' medication profiles and make evidence-based recommendations to healthcare providers.
• Serve as the plan representative for state fair hearings.
• Complete other duties and projects as assigned.

Requirements

• Doctor of Pharmacy degree plus current knowledge and expertise in clinical pharmacology and disease states; equivalent combination of education and experience may also qualify.
• Current, valid, and unrestricted California state registered pharmacist license.

Qualifications

• Experience in pharmacy practice or residency in managed care, ambulatory care, or pharmacy practice.
• CMS, DHCS, DMHC, and/or NCQA audit experience.
• Bilingual in English and one of CalOptima Health’s defined threshold languages (Arabic, Chinese, Farsi, Korean, Russian, Spanish, Vietnamese).

Skills

• Develop rapport and maintain effective working relationships with diverse internal and external contacts.
• Work independently and exercise sound judgment.
• Communicate clearly and concisely, both orally and in writing.
• Work a flexible schedule, including evenings and weekends.
• Organize, analyze, problem-solve, and manage projects efficiently.
• Work in a fast-paced environment and manage multiple projects.
• Motivate and lead multi-program teams and external committees/coalitions.
• Utilize Microsoft Office (Word, Outlook, Excel, PowerPoint) and job-specific applications/systems.

Physical Requirements

• Ability to visually read information from computer screens, forms, and printed materials.
• Ability to speak clearly in conversation and general communication.
• Hearing ability for verbal communication via telephone and face-to-face interactions.
• Manual dexterity for typing, writing, standing, reaching, flexibility, and body movement (bending, crouching, walking, kneeling, prolonged sitting).
• Lifting and moving objects, patients, and/or equipment weighing 10 to 25 pounds.

Benefits

• Competitive compensation: Pay Grade 316 – $120,881 - $193,410 ($58.12 - $92.9856/hour), based on education, experience, and internal equity.
• Comprehensive benefits package and CalPERS pension program.
• Generous PTO program and work-life balance.
• Wellness programs, tuition reimbursement, and professional development opportunities.
• Career development and flexible scheduling.

Work Environment

Work is typically indoors and sedentary, subject to schedule changes and variable hours, with occasional travel. Noise levels are usually moderate. If located at PACE, work may involve a clinical setting serving the frail and elderly, with potential exposure to harmful or hazardous conditions and moderate to loud noise levels. Community-based work may involve occasional outdoor exposure in varied temperatures.