Clinical Pharmacist
2 days ago
CalOptima Health is seeking a highly motivated and experienced Clinical Pharmacist to join our Pharmacy Management team.
Key Responsibilities:- Develop and implement drug utilization management strategies to promote clinically appropriate prescribing practices.
- Research and update drug utilization criteria to ensure alignment with CalOptima Health's formulary, regulatory guidelines, and national clinical practice guidelines.
- Collaborate with the Pharmacy Benefit Manager (PBM) and other stakeholders to drive pharmacy initiatives and clinical programs.
- Participate in medication review, disease state management, and other clinical quality improvement programs.
- Develop and maintain relationships with prescribers, pharmacies, and other healthcare professionals to promote effective medication use.
- Generate and analyze claims and utilization reports to track trends in drug utilization and identify opportunities for targeted utilization management activities.
- Assist the Pharmacy Director and Manager of Clinical Pharmacists in the preparation of drug monographs and utilization reports for the Pharmacy and Therapeutics committee.
- Utilize clinical and regulatory guidelines in the review of drug prior authorization and appeals requests.
- Adhere to regulatory compliance and quality guidelines as well as CalOptima Health's policies and procedures.
- Doctor of Pharmacy degree required.
- Current knowledge and expertise in clinical pharmacology and disease states required.
- Experience in pharmacy practice or residency in pharmacy practice preferred.
- Centers for Medicare & Medicaid Services (CMS), Department of Managed Health Care (DMHC), and/or National Committee for Quality Assurance (NCQA) audit experience preferred.
- Bilingual in English and one of CalOptima Health's defined threshold languages (Arabic, Chinese, Farsi, Korean, Spanish, Vietnamese) preferred.
Work is typically indoors and sedentary, with occasional travel as needed.
Employee will occasionally work outdoors in varied temperatures.
There may be harmful or hazardous environmental conditions present for this job.
The noise level in this work environment is usually moderate to loud.
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