Pharmacists jobs

JOB DESCRIPTION

JOB TITLE: Clinical Pharmacist FLSA STATUS: Exempt

DEPARTMENT: Pharmacy Services

REPORTS TO: Pharmacy Services Manager

JOB SUMMARY: The Pharmacist will provide clinical and operational pharmacy expertise to support Imperial Health Plan’s Medicare Advantage and Marketplace health plans. This role ensures safe, effective, and cost-efficient use of medications across the member population through collaboration with internal teams, external Pharmacy Benefit Managers (PBMs), providers, and other stakeholders. The Pharmacist will participate in formulary management, clinical program development, and quality initiatives while maintaining compliance with federal and state regulations.

ESSENTIAL JOB FUNCTIONS:

Review clinical data to support utilization management, prior authorizations, and medication therapy programs.
Monitor prescription claims and drug utilization for compliance, safety, and cost-effectiveness.
Provide clinical guidance on pharmacy policies, formulary coverage, and drug therapies.
Collaborate regularly with PBM partners to ensure accurate claims processing and program oversight.
Assist in the development, implementation, and maintenance of Medicare Advantage and Marketplace formularies.
Participate in IDT meetings to review member care plans and provide medication recommendations.
Support pharmacy-related quality initiatives, Star Ratings, HEDIS measures, and regulatory compliance.
Apply Six Sigma or continuous improvement methodologies to optimize pharmacy operations.
Manage multiple projects and deadlines efficiently, providing timely support to leadership and cross-functional teams.
Maintains current registration, existing studies and new legislation, anticipates legislation, and advises management on needed actions.
Contributes to team effort by accomplishing related results as needed.
Take on additional duties and tasks as required, in alignment with departmental needs and organizational goals
Maintains regular and consistent attendance.
Adheres to Compliance Plan and HIPAA regulations.

MARGINAL JOB FUNCTIONS:

Takes on special projects as needed.
Performs other duties as assigned.

BEHAVIORAL EXPECTATIONS:

Behavioral Expectations

Continuous Learning
a. Attends staff meetings as required.
b. Participates in required training, seminars, and workshops to maintain professional knowledge, licensure requirements, and competencies.
Customer Focus
a. Maintains client, provider, and member confidentiality and privacy in accordance with HIPAA regulations and Imperial Health Plan’s Standards of Conduct.
b. Maintains professional communication and positive working relationships with supervisors, coworkers, providers, and other staff.
Quality / Process Improvement / Safety
a. Reports security, health, or safety concerns to the appropriate supervisor as soon as practicable.
b. Demonstrates and supports a culture of safety in all duties performed.
c. Follows established policies and procedures and complies with all regulatory standards established by governing entities.
Accountability & Professionalism
a. Demonstrates professionalism, integrity, and ethical conduct in all job responsibilities.
b. Completes assigned tasks accurately and within required timeframes.
c. Demonstrates accountability for work performed and takes initiative to resolve issues.
d. Maintains compliance with company policies, regulatory requirements, and applicable laws.

POSITION REQUIREMENTS:

EDUCATION/EXPERIENCE/LICENSURE:

Doctor of Pharmacy (PharmD) required.
Active pharmacist license in the state of California.
3–5 years of managed care pharmacy experience preferred, including PBM collaboration.
Knowledge of Medicare Advantage, Marketplace, or commercial health plans is a plus.

SKILLS/KNOWLEDGE/ABILITY:

Strong knowledge of managed care pharmacy operations, including Medicare Advantage and Marketplace programs.
Expertise in formulary management, prior authorization, and medication utilization management.
Ability to interpret clinical data and provide evidence-based medication recommendations.
Familiarity with PBM processes, oversight, and performance monitoring.
Knowledge of federal and state regulations, CMS requirements, and quality measures (Star Ratings, HEDIS, SUPD).
Proficiency in Six Sigma, Lean, or other continuous improvement methodologies.
Strong analytical and problem-solving skills, with attention to detail.
Excellent communication and collaboration skills for working with interdisciplinary teams, providers, and PBMs.
Effective time management and project management abilities to handle multiple priorities and deadlines.
Ability to educate and guide internal teams, providers, and members on pharmacy programs and clinical policies.

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