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.
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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
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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
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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).
OUR BENEFITS
Available for all regular Alliance employees working more than 30 hours per week. Some benefits are available on a pro-rated basis for part-time employees. These benefits are unavailable to temporary employees while on an assignment with the Alliance.
- Medical, Dental and Vision Plans
- Ample Paid Time Off
- 12 Paid Holidays per year
- 401(a) Retirement Plan
- 457 Deferred Compensation Plan
- Robust Health and Wellness Program
- Onsite EV Charging Stations
ABOUT US
We are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us.
Join us at Central California Alliance for Health (the Alliance), where you will be part of a culture that is respectful, diverse, professional and fun, and where you are empowered to do your best work. As a regional non-profit health plan, we serve members in Mariposa, Merced, Monterey, San Benito and Santa Cruz counties. To learn more about us, take a look at our Fact Sheet.
The Alliance is an equal employment opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender perception or identity, national origin, age, marital status, protected veteran status, or disability status. We are an E-Verify participating employer
At this time the Alliance does not provide any type of sponsorship. Applicants must be currently authorized to work in the United States on a full-time, ongoing basis without current or future needs for any type of employer supported or provided sponsorship.
