Clinical Pharmacist - Medicare

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Location: Mariposa County, California; Merced County, California; Monterey County, California; San Benito County, California; Santa Cruz County, California

We have a remote opportunity to join the Pharmacy Team as a Clinical Pharmacist - Medicare in a managed care setting at the Alliance.

WHAT YOU'LL BE RESPONSIBLE FOR

• Developing, implementing and maintaining clinical pharmacy programs, such as medication therapy management, medication adherence, and disease state management. 
• Performing drug utilization review (DUR) to promote appropriate medication use. 
• Performing utilization and authorization review using applicable policies, assists the Pharmacy Director with developing cost-effective pharmacy measures, provides delegate oversight of Pharmacy Benefits Manager (PBM), and advising on claims issues.  
• Working with the pharmacy and medical communities relative to prescription medications and therapeutic management.  

ABOUT THE TEAM

Our mission is to improve member health outcomes and quality of pharmacy services by enhancing care coordination, medication management, and medication adherence in collaboration with our internal teams and community partners.

We handle pharmacy authorizations, Alliance formulary, pharmacy utilization and projects.

WHAT YOU'LL NEED TO BE SUCCESSFUL

To read the full position description, and list of requirements click here.

• Knowledge of:
  • Drug utilization review
  • Medicare Part D regulations, formulary management, and medication therapy management (MTM) services
  • Computerized drug programs
  • Drugs and supplies required in the operation of a pharmacy
  • Drug formularies and drug billings
• Ability to:
  • Act as a technical resource and explain clinical information, regulations, processes, and programs related to area of assignment
  • Learn and apply the concepts associated with coordination of benefits between Medicare and Medi-Cal
  • Interpret and apply complex principles, policies, terms and procedures
  • Identify issues and potential risks, conduct research, gather and analyze information, reach logical and sound conclusions, and make recommendations for action
  • Assist with the development and implementation of projects, systems, programs, policies, and procedures
• Education and Experience:
  • Current active and unrestricted license as a Pharmacist issued by the state of California
  • Doctor of Pharmacy (Pharm. D.) degree  and three years of experience as a practicing pharmacist in a health plan, hospital, pharmacy, and/or retail pharmacy, which included experience with drug utilization review, prior authorization activities, formularies, and drug billings and a minimum of two years of experience working with Medicare Part D regulations (one year of experience in a managed care environment or clinical residency may substitute for the three years of experience); or an equivalent combination of education and experience may be qualifying.

OTHER INFORMATION

• We are in a hybrid work environment and we anticipate that the interview process will take place remotely via Microsoft Teams.
• While some staff may work full telecommuting schedules, attendance at quarterly company-wide events or department meetings will be expected.
• In-office or in-community presence may be required for some positions and is dependent on business need. Details about this can be reviewed during the interview process.

The full compensation range for this position is listed by location below. 

The actual compensation for this role will be determined by our compensation philosophy, analysis of the selected candidate's qualifications (direct or transferrable experience related to the position, education or training), as well as other factors (internal equity, market factors, and geographic location).

Apply for Clinical Pharmacist - Medicare