Clinical Pharmacist - Pharmaceutical Services

Overview What you can expect!  Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an  authentic experience! The Clinical Pharmacist – Pharmaceutical Services is responsible for providing patient-specific medication reviews and developing recommendations for medical drug utilization management (RxUM), Medication Therapy Management (MTM), medication adherence, pharmacy clinical quality, including but not limited to, HEDIS, MCAS and STARS measures, and member issue resolution. This position will resolve medication and pharmacy issues for members who are triaged to pharmacy from the Member Services Call Center or other internal departments. The Clinical Pharmacist – Pharmaceutical Services will communicate verbal and written clinical recommendations to members, prescribers, and pharmacies.  The Clinical Pharmacist – Pharmaceutical Services will serve as a subject matter expert for audits, projects, quality improvement process enhancements, LEAN projects and other IEHP initiatives. The position may be assigned to a specific area or work in multiple areas on a rotating basis. Commitment to Quality: The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation. Additional Benefits Perks IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more. Competitive salary. CalPERS retirement. State of the art fitness center on-site. Medical Insurance with Dental and Vision. Life, short-term, and long-term disability options Career advancement opportunities and professional development. Wellness programs that promote a healthy work-life balance. Flexible Spending Account – Health Care/Childcare CalPERS retirement 457(b) option with a contribution match Paid life insurance for employees Pet care insurance Key Responsibilities Perform patient-specific medication reviews and develop recommendations using established medical treatment protocols and clinical practice guidelines in compliance with regulatory timelines and standards.  Medical drug utilization management (RxUM) - Evaluate adjudicate prior authorization requests for medical drugs. Evaluate and review drug claims for clinical appropriateness. Medication Therapy Management (MTM) - Perform Comprehensive Medication Reviews (CMR) in compliance with CMS standards and timelines.  Medication adherence - Evaluate and develop medication adherence recommendations to members and prescribers.  Coordinates with members, prescribers, and pharmacies to assure patient obtains medication and understands instructions for use. Pharmacy Clinical Quality, including but not limited to, HEDIS, MCAS and STARS measures - Evaluate and develop patient-specific recommendations to support pharmacy clinical quality priorities. Member issue resolution - Resolve medication and pharmacy issues for members who are triaged to pharmacy from the Member Services Call Center or other internal departments. Formulary implementation, management, and maintenance assistance. Communicate verbal and written clinical recommendations to members, prescribers, and pharmacies regarding medication use, medication adherence, therapy changes, and risks. Initiate outbound calls to members and prescribers to explain clinical recommendations that were developed during the clinical medication reviews. Act as subject matter expert (SME) for internal and external regulatory and operational audits, projects, quality improvement process enhancements, LEAN projects and other IEHP initiatives. Any other duties required as assigned by Pharmacy Leadership ensuring Health Plan operations are successful. Qualifications Education & Requirements  Two (2) or more years of experience in managed care pharmacy setting -OR- successful completion of a one (1) year Pharmacy Managed Care residency One (1) year of medical drug prior authorization and/or Medication Therapy Management experience preferred Doctor of Pharmacy (Pharm. D.) from an accredited institution required Possession of an active, unrestricted, and unencumbered Registered Pharmacist license issued by the California State Board of Pharmacy required Key Qualifications Strong clinical baseline knowledge of current medical treatment protocols and clinical practice guidelines Working knowledge of regulatory standards and timelines for Medi-Cal, Medicare, and Covered California lines of business Bilingual preferred Proficiency with health plan electronic medical records systems (i.e. MHK, Meditrac) Excellent written and verbal communication skills Strong drug information research skills Excellent communication and interpersonal skills Detail oriented Ability to communicate and work effectively with a variety of stakeholders and maintain positive working relationships with internal and external contacts at all levels Schedule will adjust based on business need which may include evenings, holidays, and weekends Position is eligible for telecommuting/remote work location upon completing the necessary steps and receiving HR approval All IEHP positions approved for telecommute or hybrid work locations may periodically be required to report to IEHP’s main campus for mandatory in-person meetings or for other business needs as determined by IEHP leadership Start your journey towards a thriving future with IEHP and apply TODAY ! Work Model Location Telecommute (All IEHP positions approved for telecommute work locations may periodically be required to report to IEHP’s main campus for mandatory in-person meetings or for other business needs as determined by IEHP leadership) Schedule will adjust based on business need which may include evenings, holidays, and weekends Pay