Clinical Pharmacist

Duties & Responsibilities :

• % - Pharmacy Management Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability. Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals / priorities for the department. Generates and analyzes claims and utilization reports to track general trends in drug utilization and to identify potential targeted utilization management activities. Develops and updates drug utilization criteria. Develops and maintains contacts and relationships with providers key to successful interaction and intervention activities. Participates in medication review, disease state management and other clinical quality improvement programs such as Stars and Healthcare Effectiveness Data and Information Set (HEDIS) Quality Improvement Programs, Medication Therapy Management (MTM), interdisciplinary care teams and PACE. Assists the Pharmacy Director and the Manager of Clinical Pharmacists in the preparation of drug monographs and utilization reports for the Pharmacy and Therapeutics committee. Utilizes clinical and regulatory guidelines in the review of drug prior authorization and appeals requests. Adheres to regulatory compliance and quality guidelines as well as CalOptima Health's policies and procedures. Updates CalOptima Health's pharmacy policies and develops new policies and procedures when needed. Works with management to recommend, develop and implement target drug utilization intervention programs and other Drug Utilization Review / Drug Utilization Evaluation (DUR / DUE) activities. Works with the Manager of Clinical Pharmacists and within Medical Management (, with data manager, case managers, etc.) on various data integration, disease management and outcomes projects. Reviews members' medication profiles and makes recommendations to health care providers based on evidence-based medicine and national guidelines for disease management as part of CalOptima Health's polypharmacy program. Serves as the plan representative for state fair hearings. Resolves complaints, grievances and appeals.
• % - Other Completes other duties and projects as assigned.

Minimum Qualifications :

Preferred Qualifications :

Required Licensure / Certifications :

Knowledge & Abilities :

Physical Requirements (With or Without Accommodations) :

Work Environment :

If located at the , Building or a remote work location :

If located at PACE :

If located in the Community :

About CalOptima Health :

CalOptima Health is the single largest health plan in Orange County, serving one in four residents. Our motto — "Better. Together.” — is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health. We are continuing to build a culture that promotes diversity and inclusion within our community where employees have a sense of belonging, and are valued for their ideas, contributions, and their unique individual perspectives they bring. CalOptima Health has been recognized as one of Orange County's best places to work, so we know there is something special about our organization. It is why people choose to work here and why they choose to stay!

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.