Clinical Pharmacist

FLSA Status: Exempt

Department: Pharmacy

Reports To: Director of Pharmacy

GENERAL DESCRIPTION OF POSITION

The Clinical Pharmacist supports clinical activities and projects required to meet regulatory and compliance obligations in all lines of business (Medi-Cal and Dual Connect) and to promote overall improvements in the quality of services provided by SCFHP. This position typically reports to the Director of Pharmacy or other appropriate administrator.

ESSENTIAL DUTIES AND RESPONSIBILITIES

To perform this job successfully, an individual must be able to perform each essential duty listed below satisfactorily.

• Review prior authorization requests delegated to the pharmacy team in the UM queue, ensuring compliance with DHCS and CMS turnaround requirements and supporting the department's timely review rate goal of over 95%.
• Develop, implement, and manage pharmacy clinical programs that support Medicare Part D Star measures, HEDIS measures, MCAS performance metrics, and DUE programs, including creating provider and member education materials, conducting outreach calls, writing call-scripts and workflows, and performing outcomes analysis.
• Serve as the primary point of contact for all clinical pharmacy inquiries from Member Services, Grievances & Appeals, Utilization Management, and Case Management.
• Provide oversight of the pharmacy benefit manager (PBM) and delegated medical groups and identify opportunities to improve quality, performance, and alignment with clinical and operational standards.
• Participate in audits including CMS, NCQA and DCHS.
• Actively participate in interdisciplinary meetings, offering expert clinical recommendations regarding medication therapy and treatment options.
• Prepare and present Pharmacy & Therapeutics (P&T) materials at quarterly meetings.
• Prepare and validate CMS-required reports accurately and in a timely manner.
• Perform any other related duties as required or assigned by the director of pharmacy.

REQUIREMENTS - Required (R) Desired (D)

The requirements listed below are representative of the knowledge, skill, and/or ability required or desired.

• Doctorate Degree in Pharmacy or equivalent education or experience. (R)
• Available to cover Pharmacy UM queue on weekends and holidays. (R)
• Minimum of one to three years of experience in managed care pharmacy. (R)
• Current active California Board of Pharmacy Licensed Pharmacist. (R)
• Strong knowledge of clinical and pharmacy operations and best practices, and treatment guidelines. (R)
• Advanced knowledge in Excel. (D)
• Strong knowledge of complete healthcare system operations including hospitals, long-term care, and community pharmacy. (R)
• Strong working knowledge and the ability to efficiently operate all applicable computer software including Outlook. Word and Excel and the ability to use the Plan's Core database. (R)
• Ability to use a keyboard with moderate speed and a high level of accuracy. (R)
• Ability to maintain confidentiality. (R)
• Ability to comply with all SCFHP policies and procedures. (R)

WORKING CONDITIONS

Generally, duties are primarily performed in an office environment while sitting or standing at a desk. Incumbents are subject to regular contact with co-workers, managers, external partners, and vendors in person, by telephone and via work-related electronic communications.

PHYSICAL REQUIREMENTS

Incumbents must be able to perform the essential functions of this job, with or without reasonable accommodation.

• Mobility Requirements: regular bending at the waist, and reaching overhead, above the shoulders and horizontally, to retrieve and store files and supplies; and sit or stand for extended periods of time. (R)
• Lifting Requirements: regularly lift and carry files, notebooks, and office supplies that may weigh up to 5 pounds. (R)
• Visual Requirements: ability to read information in printed materials and on a computer screen; perform close-up work; clarity of vision is required at 20 inches or less. (R)
• Dexterity Requirements: regular use of hands, wrists, and finger movements; ability to perform repetitive motion (keyboard); writing (note-taking); ability to operate a computer keyboard and other office equipment. (R)
• Hearing/Talking Requirements: ability to hear normal speech, hear and talk to exchange information in person and on telephone. (R)
• Reasoning Requirements: ability to think and work effectively under pressure; ability to effectively serve customers; decision making, maintain a concentrated level of attention to information communicated in person, by telephone, and electronically throughout a typical workday; attention to detail. (R)

ENVIRONMENTAL CONDITIONS

General office conditions. May be exposed to moderate noise levels.

Skills

Analysis Skills, Best Practices, Case Management, Clinical Practices/Protocols, Clinical Support, Compensation and Benefits, Computer Software, Content Management Systems (CMS), Detail Oriented, Healthcare, Healthcare Effectiveness Data and Information Set (HEDIS), Hospital, Keyboards, Long-Term Care, Maintain Compliance, Managed Care, Medi-Cal, Medicare, Medications, Member Orientation, Microsoft Excel, Microsoft Outlook, Microsoft Word, National Committee for Quality Assurance (NCQA), Office Equipment, Performance Management, Performance Metrics, Pharmacy, Physical Demands, QoS (Quality of Service), Quality Management, Regulatory Compliance, Scripting (Scripting Languages), System Operations, Time Management, Utilization Management

About the Company

Santa Clara Family Health Plan