Be an early applicantLess than 25 applicants

Company

Western Growers · 3 days ago

Clinical Pharmacist I

United States

Full-time

Remote

Entry, Mid Level

$110K/yr - $138K/yr

1+ years exp

Maximize your interview chances

FinanceService Industry

Insider Connection @Western Growers

Discover valuable connections within the company who might provide insights and potential referrals.
Get 3x more responses when you reach out via email instead of LinkedIn.

Responsibilities

Work with internal partners to develop, and maintain, a pharmacy claims audit program to support internal pharmacy and client contracts.

Assist in developing criteria for medication analysis and claims monitoring in alignment with Clinical Operations initiatives and regulatory reporting requirements.

Collaborate on the development of clinical edits for claims and drug utilization enhancements.

Help evaluate quality controls and suggest performance improvement opportunities in pharmacy practices.

Support the development and maintenance of a pharmacy claims audit program to meet internal and client needs.

Assist in expansion, conversion and management of Cedar clinics sites and health fairs.

Work with our educational partners in establishing meaningful and impactful programs for the benefit of members and education of new pharmacy students and interns.

Support analytics and outcomes initiatives related to clinical programs.

Audit claims for accuracy in pricing, appropriateness or for potential fraud waste and abuse.

Educate and precept pharmacy students and interns during experiential rotations.

Contribute to operational improvements and initiatives identified by leadership.

Assist with analytics and outcomes related to clinical programs.

Review and make determinations for prior authorization requests based on member benefits and coverage.

Help oversee drug utilization review and medication therapy management programs to ensure compliance with plan and PBM requirements.

Support systematic reviews of prescription claims to meet strategic initiatives.

Provide clinical support and drug information expertise to internal teams.

Stay updated on drug information and disease management as it relates to utilization reviews.

Utilize all capabilities to satisfy one mission — to enhance the competitiveness and profitability of our members.

Maintain a valid CA Pharmacist License.

Attend client or off-site meetings or conferences as requested by the Supervisor.

Maintain internet speed of 40 MB download and 10 MB upload and router with wired Ethernet.

Maintain a HIPAA-compliant workstation and utilize appropriate security techniques to ensure HIPAA-required protection of all confidential/protected client data.

Maintain and service safety equipment (e.g., smoke detector, fire extinguisher, first aid kit).

All other duties as assigned.

Qualification

Find out how your skills align with this job's requirements. If anything seems off, you can easily click on the tags to select or unselect skills to reflect your actual expertise.

Retail Pharmacy ExperienceManaged Care Pharmacy ExperienceDoctorate in PharmacyRegistered Pharmacist LicensePharmacy Benefit Management (PBM)Pharmacy AuditingDrug Utilization ReviewMedication Therapy ManagementClinical Program SupportDrug Information ExpertiseHIPAA ComplianceMicrosoft Office Proficiency

Required

Minimum one (1) to three (3) years of retail pharmacy experience

One (1) year of managed care pharmacy internship, residency or similar experience in a Pharmacy Benefit Management (PBM) setting

Doctorate in Pharmacy

Registered pharmacist license in California or equivalent

Valid CA Registered Pharmacist License

Ability to understand complex situations and make independent decisions

Highly proficient in end-user computer skills with Microsoft Office applications

Excellent written and verbal communication skills

Proven ability to multi-task multiple projects and demands at one time

Internet access provided by a cable or fiber provider with 40 MB download and 10 MB upload speeds

Home router with wired Ethernet

A designated room for your office or steps taken to protect company information

A functioning smoke detector, fire extinguisher, and first aid kit on site

Maintain a valid CA Pharmacist License

Maintain internet speed of 40 MB download and 10 MB upload and router with wired Ethernet

Maintain a HIPAA-compliant workstation and utilize appropriate security techniques to ensure HIPAA-required protection of all confidential/protected client data