Clinical Pharmacist

POSITION
Clinical Pharmacist

Position Type: Temporary
Schedule: M-F, 8:00 am - 5:00 pm; Remote (Candidates must reside in Southern California)
Assignment Length: Approximately 6-Months, possibly longer.

DESCRIPTION
The Clinical Pharmacist – Pharmaceutical Services is responsible for providing patient-specific medication reviews and developing recommendations for medical drug utilization management (RxUM), Medication Therapy Management (MTM), medication adherence, pharmacy clinical quality, including but not limited to, HEDIS, MCAS and STARS measures, and member issue resolution. This position will resolve medication and pharmacy issues for members who are triaged to pharmacy from the Member Services Call Center or other internal departments. The Clinical Pharmacist – Pharmaceutical Services will communicate verbal and written clinical recommendations to members, prescribers, and pharmacies. The Clinical Pharmacist – Pharmaceutical Services will serve as a subject matter expert for audits, projects, quality improvement process enhancements, LEAN projects and other Health Plan initiatives. The position may be assigned to a specific area or work in multiple areas on a rotating basis.

KEY RESPONSIBILITIES

1. Perform patient-specific medication reviews and develop recommendations using established medical treatment protocols and clinical practice guidelines in compliance with regulatory timelines and standards
   • Medical drug utilization management (RxUM) - Evaluate adjudicate prior authorization requests for medical drugs. Evaluate and review drug claims for clinical appropriateness
   • Medication Therapy Management (MTM) - Perform Comprehensive Medication Reviews (CMR) in compliance with CMS standards and timelines
   • Medication adherence - Evaluate and develop medication adherence recommendations to members and prescribers. Coordinates with members, prescribers, and pharmacies to assure patient obtains medication and understands instructions for use
   • Pharmacy Clinical Quality, including but not limited to, HEDIS, MCAS and STARS measures - Evaluate and develop patient-specific recommendations to support pharmacy clinical quality priorities
   • Member issue resolution - Resolve medication and pharmacy issues for members who are triaged to pharmacy from the Member Services Call Center or other internal departments
   • Formulary implementation, management, and maintenance assistance
2. Communicate verbal and written clinical recommendations to members, prescribers, and pharmacies regarding medication use, medication adherence, therapy changes, and risks. Initiate outbound calls to members and prescribers to explain clinical recommendations that were developed during the clinical medication reviews
3. Act as subject matter expert (SME) for internal and external regulatory and operational audits, projects, quality improvement process enhancements, LEAN projects and other Health Plan initiatives.
4. Any other duties required as assigned by Pharmacy Leadership ensuring Health Plan operations are successful

REQUIREMENTS

• Two (2) or more years of experience in managed care pharmacy setting -OR- successful completion of a one (1) year Pharmacy Managed Care residency
  • One (1) year of medical drug prior authorization and/or Medication Therapy Management experience preferred
• Doctor of Pharmacy (Pharm. D.) from an accredited institution required
• Possession of an active, unrestricted, and unencumbered Registered Pharmacist license issued by the California State Board of Pharmacy required

Key Qualifications

• Strong clinical baseline knowledge of current medical treatment protocols and clinical practice guidelines
• Working knowledge of regulatory standards and timelines for Medi-Cal, Medicare, and Covered California lines of business
• Bilingual preferred
• Proficiency with health plan electronic medical records systems (i.e. MHK, Meditrac)
• Excellent written and verbal communication skills
• Strong drug information research skills
• Excellent communication and interpersonal skills
• Detail oriented
• Ability to communicate and work effectively with a variety of stakeholders and maintain positive working relationships with internal and external contacts at all levels
• Schedule will adjust based on business need which may include evenings, holidays, and weekends