Clinical Pharmacist

Santa Clara Family Health Plan • San Jose, CA

17d • Onsite

About The Position

The Clinical Pharmacist supports clinical activities and projects required to meet regulatory and compliance obligations in all lines of business (Medi-Cal and Dual Connect) and to promote overall improvements in the quality of services provided by SCFHP. This position typically reports to the Director of Pharmacy or other appropriate administrator.

Requirements

• Doctorate Degree in Pharmacy or equivalent education or experience.
• Available to cover Pharmacy UM queue on weekends and holidays.
• Minimum of one to three years of experience in managed care pharmacy.
• Current active California Board of Pharmacy Licensed Pharmacist.
• Strong knowledge of clinical and pharmacy operations and best practices, and treatment guidelines.
• Strong knowledge of complete healthcare system operations including hospitals, long-term care, and community pharmacy.
• Strong working knowledge and the ability to efficiently operate all applicable computer software including Outlook. Word and Excel and the ability to use the Plan’s Core database.
• Ability to use a keyboard with moderate speed and a high level of accuracy.
• Ability to maintain confidentiality.
• Ability to comply with all SCFHP policies and procedures.

Nice To Haves

• Advanced knowledge in Excel.

Responsibilities

• Review prior authorization requests delegated to the pharmacy team in the UM queue, ensuring compliance with DHCS and CMS turnaround requirements and supporting the department’s timely review rate goal of over 95%.
• Develop, implement, and manage pharmacy clinical programs that support Medicare Part D Star measures, HEDIS measures, MCAS performance metrics, and DUE programs, including creating provider and member education materials, conducting outreach calls, writing call-scripts and workflows, and performing outcomes analysis.
• Serve as the primary point of contact for all clinical pharmacy inquiries from Member Services, Grievances & Appeals, Utilization Management, and Case Management.
• Provide oversight of the pharmacy benefit manager (PBM) and delegated medical groups and identify opportunities to improve quality, performance, and alignment with clinical and operational standards.
• Participate in audits including CMS, NCQA and DCHS.
• Actively participate in interdisciplinary meetings, offering expert clinical recommendations regarding medication therapy and treatment options.
• Prepare and present Pharmacy & Therapeutics (P&T) materials at quarterly meetings.
• Prepare and validate CMS-required reports accurately and in a timely manner.
• Perform any other related duties as required or assigned by the director of pharmacy.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Ph.D. or professional degree