PHARMACIST

VIVANT HEALTH•Sacramento, CA

11d•$155,000 - $170,000•Onsite

About The Position

The Clinical Pharmacist supports managed pharmacy operations across Medicare Advantage and Medi-Cal, focusing primarily on utilization management, prior authorization, formulary management, and specialty pharmacy cost optimization. The role uses clinical expertise, pharmacy claims analytics, and evidence-based practices to improve medication access, quality performance, HEDIS and Medicare Star Ratings, and population health outcomes. In collaboration with health plans, providers, and internal teams, the pharmacist supports regulatory compliance, provider engagement, and value-based care initiatives to promote appropriate medication use and manage total cost of care.

Requirements

Minimum of 3–5 years of clinical pharmacy experience.
Experience supporting managed care pharmacy programs, Medicare Advantage, Medi-Cal, and Medicare Part D.
Demonstrated expertise in utilization management, prior authorization, formulary management, medication therapy management (MTM), and evidence-based clinical review.
Working knowledge of applicable CMS, DHCS, NCQA, URAC, regulatory, accreditation, and organizational requirements.
Knowledge of HEDIS measures, Medicare Star Ratings, CAHPS, population health management, quality improvement, and value-based care initiatives.
Strong analytical skills, including experience evaluating pharmacy claims, utilization trends, specialty pharmacy costs, clinical information, and total cost of care to identify opportunities for improved quality, outcomes, and cost-effectiveness.
Ability to collaborate effectively with providers, health plans, pharmacy partners, and interdisciplinary teams on medication management, clinical policies, utilization initiatives, and quality improvement efforts.
Excellent oral and written communication, presentation, and interpersonal skills, including the ability to communicate clinical and technical information to diverse audiences.
Proficiency with Microsoft Office and pharmacy and clinical information systems, and ability to learn and effectively use new applications and technologies.
Ability to work independently, exercise sound professional judgment, prioritize competing responsibilities, and collaborate effectively in a fast-paced team environment.
Commitment to confidentiality, accuracy, continuous learning, regulatory compliance, and high-quality service.
Ability to maintain a professional demeanor and represent the Company effectively in interactions with providers, health plans, vendors, members, and other stakeholders.
Doctor of Pharmacy (PharmD) degree from an accredited program.
Active California pharmacist license in good standing.

Nice To Haves

Clinical pharmacy experience in managed care, health plan operations, or population health management.
Experience supporting Pharmacy and Therapeutics (P&T) Committee activities, including formulary evaluation, clinical review, and assessment of therapeutic alternatives.
Board certification (BCPS, BCACP, or relevant specialty).

Responsibilities

Review outpatient prior authorizations and specialty drug requests using applicable Medi-Cal, Medicare, and Vivant Health criteria.
Apply formulary requirements, step therapy, and evidence-based guidelines; recommend therapeutic alternatives when appropriate.
Support coverage determinations, appeals, and clinical documentation.
Conduct targeted medication reviews, including MTM, CMRs, TMRs, medication reconciliation, and adherence interventions for high-risk or priority members.
Review flagged pharmacy claims, high-cost therapies, and high-utilization specialties for clinical appropriateness and cost impact.
Support transitions of care and provide brief patient counseling for selected cases.
Support priority HEDIS and Medicare Star Ratings measures, particularly medication adherence and access.
Collaborate with Quality, Population Health, and Care Management teams on targeted pharmacy interventions.
Conduct periodic performance reporting and participate in focused quality improvement initiatives.
Maintain compliance with applicable CMS, DHCS, NCQA, URAC, and organizational requirements.
Support pharmacy-related audits, accreditation activities, and utilization management documentation.
Analyze selected high-cost or high-frequency therapies and identify opportunities to improve cost-effectiveness.
Review flagged cases for potential fraud, waste, and abuse.
Serve as a pharmacy resource for clinical, care management, and provider-relations teams.
Collaborate with providers and health plans on prior authorizations, formulary issues, drug utilization, and coverage criteria.
Manage pharmacy-related programs and collaboration with local educational institutions.
Participate in scheduled health plan meetings, case conferences, and targeted provider education.
Provide education on pharmacy policies, utilization criteria, and relevant regulatory updates.
Enforce Company policies and safety procedures.
Maintain job knowledge through educational opportunities, professional publications, professional networks, and professional organizations.
Maintain IPA and Health Plan compliance standards.
Perform other duties as assigned.