Pharmacy Consultant

KAI Partners, Inc.•Roseville, CA

2d•$135,000 - $175,000

About The Position

KAI Partners, Inc. (KAIP) is currently seeking a Pharmacist Consultant to serve as a subject matter expert providing clinical guidance, regulatory insight, and data-driven expertise across pharmacy and healthcare initiatives. This role combines strong clinical pharmacy knowledge with advanced analytical skills to interpret complex data, generate executive-level summaries, and support compliance efforts—particularly during legislative and regulatory bill cycles. The Pharmacist Consultant will evaluate clinical and operational pharmacy initiatives, analyze performance and utilization data, interpret regulatory impacts, and translate findings into actionable recommendations for leadership and stakeholders. This individual will play a critical role in ensuring that pharmacy programs align with federal and state regulations, CMS guidance, and evolving healthcare legislation.

Requirements

Active Pharmacist license (RPh or PharmD) in good standing.
Strong clinical knowledge across therapeutic classes, formulary management, and pharmacy benefit structures.
Advanced analytical skills with the ability to interpret large datasets, identify patterns, and translate findings into strategic insights.
Ability to synthesize complex regulatory and legislative language into clear operational implications.
Strong understanding of state and federal pharmacy regulations, including CMS, Medicaid, Medicare Part D, and HIPAA requirements.
Experience reviewing and summarizing proposed legislation, regulatory guidance, and policy changes.
Excellent written and verbal communication skills, with the ability to present complex clinical and data-driven information to both technical and non-technical audiences.
Strong critical thinking, problem-solving, and independent judgment skills.
Ability to manage multiple initiatives in a fast-paced, dynamic consulting environment.
Experience working cross-functionally with clinical, technical, and policy teams.
High attention to detail, especially in compliance, reporting, and regulatory documentation.
Active and unrestricted Pharmacist license.
5–8 years of relevant experience in clinical pharmacy, managed care, PBM operations, Medicaid/Medicare programs, or healthcare consulting.
Experience analyzing pharmacy claims data and preparing executive-level summaries and reports.

Nice To Haves

Doctor of Pharmacy (PharmD) from an accredited institution.
Experience with Medicaid, Medicare, CMS regulations, or state healthcare programs strongly preferred.
Experience supporting regulatory analysis or legislative impact assessments is highly desirable.
Experience with pharmacy benefit platforms, claims systems, MMIS, or health IT systems preferred.
Advanced degree (MPH, MBA, MHA) or board certification (e.g., BCPS) preferred.

Responsibilities

Provide regulatory guidance related to CMS, Medicaid, Medicare, HIPAA, and other applicable healthcare frameworks.
Collaborate with policy, legal, IT, analytics, and operations teams to translate regulatory and clinical requirements into actionable implementation steps.
Assist in drafting policy analyses, legislative summaries, and fiscal impact considerations related to pharmacy services.
Support the review and validation of pharmacy-related business rules, claims adjudication logic, and clinical criteria.
Develop clear, concise data summaries, executive briefings, dashboards, and reports to support internal leadership and client decision-making.
Interpret state and federal legislation during bill season and assess potential impacts to pharmacy programs, reimbursement structures, and compliance requirements.
Participate in stakeholder meetings to provide clinical interpretation of data findings and regulatory considerations.
Ensure documentation and processes align with compliance standards and audit readiness requirements.
Provide subject matter expertise during project planning, implementation, and post-implementation review phases.
Perform other duties, as assigned.