FREE ACCESS
5,000–10,000 jobs/day
See all jobs on Scoutfield
Search thousands of fresh jobs every day.
Discover
- Fresh listings
- Fast filters
- No subscription required
Create a free account and start exploring right away.
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in performing Comprehensive Medication Reviews (CMR) and developing patient-specific medication recommendations in compliance with CMS standards. Proficient in evaluating prior authorization requests and coordinating with healthcare stakeholders to ensure optimal medication management.
Highest-signal resume keywords
Doctor Of Pharmacy (Pharm. D.)Registered Pharmacist LicenseManaged Care Pharmacy ExperienceMedication Therapy Management ExperienceClinical Practice Guidelines Knowledge
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Comprehensive Medication Reviews (CMR)Prior Authorization EvaluationMedication Adherence RecommendationsDrug Claims ReviewDrug Information Research
Soft Skills
Excellent Communication SkillsInterpersonal SkillsDetail OrientedAbility To Work With Stakeholders
Tools & Technologies
Health Plan Electronic Medical Records SystemsMHKMeditrac
Certifications & Qualifications
Registered Pharmacist License
Industry Keywords
Managed CareMedi-CalMedicareCovered CaliforniaHEDISMCASSTARS Measures
About the role
Key responsibilities & impact- Perform patient-specific medication reviews and develop recommendations using established medical treatment protocols and clinical practice guidelines
- Evaluate and adjudicate prior authorization requests for medical drugs
- Evaluate and review drug claims for clinical appropriateness
- Perform Comprehensive Medication Reviews (CMR) in compliance with CMS standards and timelines
- Evaluate and develop medication adherence recommendations to members and prescribers
- Coordinate with members, prescribers, and pharmacies to assure patients obtain medication and understand instructions for use
- Evaluate and develop patient-specific recommendations to support pharmacy clinical quality priorities, including HEDIS, MCAS, and STARS measures
- Resolve medication and pharmacy issues for members triaged to pharmacy
- Assist with formulary implementation, management, and maintenance
- Communicate verbal and written clinical recommendations to members, prescribers, and pharmacies
- Initiate outbound calls to members and prescribers to explain clinical recommendations
- Act as subject matter expert for internal and external regulatory and operational audits, projects, quality improvement process enhancements, LEAN projects, and other IEHP initiatives
- Perform other assigned duties supporting successful Health Plan operations
Requirements
What you’ll need- 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
- 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 may include evenings, holidays, and weekends
Benefits
Comp & perks- Competitive salary
- CalPERS retirement
- State of the art fitness center on-site
- Medical Insurance with Dental and Vision
- Life, short-term, and long-term disability options
- Career advancement opportunities and professional development
- Wellness programs that promote a healthy work-life balance
- Flexible Spending Account – Health Care/Childcare
- 457(b) option with a contribution match
- Paid life insurance for employees
- Pet care insurance