Clinical Pharmacist, Clinical and Quality Programs

Full telework within California and lead pharmacy quality initiatives for Medi‑Cal, Medicare and Covered CA members. Clinical Pharmacist, Clinical & Quality Programs; full telework (California) or partial with >=2 days/wk in Orange, CA; exempt, ongoing role within CalOptima Health pharmacy management. - Doctor of Pharmacy (PharmD) or equivalent - Current, valid unrestricted California pharmacist license - Knowledge of clinical pharmacology, disease states, drug utilization management - Experience with managed care/ambulatory practice or residency preferred

Clinical Pharmacist, Clinical and Quality Programs

CalOptima

Join Us in this Amazing Opportunity

The Team You'll Join

We are a mission driven community‐based organization that serves member health with excellence and dignity, respecting the value and needs of each person. If you are ready to advance your career while making a difference, we encourage you to review and apply today and help us build healthier communities for all.

More About the Opportunity

We are hoping you will join us as a Clinical Pharmacist, Clinical and Quality Programs and help shape the future of healthcare where you'll be an integral part of our Pharmacy Management team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. This position has been approved to be Full Telework.

• If telework is approved, you are required to work within the State of California only and if Partial Telework, also come in to the Main Office in Orange, CA, at least two (2) days per week minimum.

The Clinical Pharmacist (Clinical and Quality Programs) is an integral part of CalOptima Health's pharmacy management team, advancing pharmacy quality initiatives and clinical programs within the Medi‐Cal, Medicare and Covered California lines of business. You will research, develop, and update drug utilization management strategies and promote clinically appropriate prescribing practices that adhere to CalOptima Health's formulary, regulatory guidelines and national clinical practice guidelines. You will interact frequently and independently with plan members, prescribers, pharmacies, collaborative care team members and the Pharmacy Benefit Manager (PBM). You will participate in clinical programs, quality measure initiatives, the development of drug utilization review criteria, fraud, waste and abuse programs, and will interface with plan members and prescribers to discuss drug therapy. Together, we are building a stronger, more equitable health system.

Your Contributions To the Team:

• 90% ‐ 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, including Stars and Healthcare Effectiveness Data and Information Set (HEDIS) Quality Improvement Programs, Medication Therapy Management (MTM), interdisciplinary care teams and drug utilization reviews.
  • Assists the Sr Director and Director 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 provides recommendations for the development of 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 Director and Medical Management team (e.g., 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.
  • Serves as the plan representative for state fair hearings.
    
    
• 10% ‐ Completes other duties and projects as assigned.

Do You Have What the Role Requires?

• Doctor of Pharmacy degree PLUS current knowledge and expertise in clinical pharmacology and disease states required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.

You'll Stand Out More If You Possess the Following:

• Experience in pharmacy practice or residency in managed care, ambulatory care or pharmacy practice.
  
• Centers for Medicare & Medicaid Services (CMS), Department of HealthCare Services (DHCS), Department of Managed Health Care (DMHC) and/or National Committee for Quality Assurance (NCQA) audit experience.
  
• Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Chinese, Farsi, Korean, Russian, Spanish, Vietnamese).

What the Regulatory Agencies Need You to Possess?

• A current, valid and unrestricted California state registered pharmacist license required.

Your Knowledge & Abilities to Bring to this Role:

• Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds.
• Work independently and exercise sound judgment.
• Communicate clearly and concisely, both orally and in writing.
• Work a flexible schedule; available to participate in evening and weekend events.
• Organize, be analytical, problem‐solve and possess project management skills.
• Work in a fast‐paced environment and in an efficient manner.
• Manage multiple projects and identify opportunities for internal and external collaboration.
• Motivate and lead multi‐program teams and external committees/coalitions.
• Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.

Your Physical Requirements (With or Without Accommodations):

• Ability to visually read information from computer screens, forms and other printed materials and information.
• Ability to speak (enunciate) clearly in conversation and general communication.
• Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face‐to‐face interactions.
• Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.
• Lifting and moving objects, patients and/or equipment 10 to 25 pounds