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.
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 in compliance with CMS standards and timelines
- Evaluate and develop medication adherence recommendations for members and prescribers
- Coordinate with members, prescribers, and pharmacies to ensure patients obtain medications and understand instructions
- Evaluate and develop patient-specific recommendations supporting pharmacy clinical quality priorities, including HEDIS, MCAS, and STARS measures
- Resolve medication and pharmacy issues triaged from the Member Services Call Center or other internal departments
- Assist with formulary implementation, management, and maintenance
- Communicate verbal and written clinical recommendations regarding medication use, adherence, therapy changes, and risks
- Initiate outbound calls to members and prescribers to explain clinical recommendations
- Serve as subject matter expert for regulatory and operational audits, projects, quality improvement enhancements, LEAN projects, and other IEHP initiatives
- Perform other duties assigned by Pharmacy Leadership
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
- 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, such as MHK and 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 varied stakeholders and maintain positive working relationships
- Schedule flexibility including 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
- Remote work location eligibility upon completing necessary steps and receiving HR approval