Job DescriptionJob Summary
Clinical Pharmacist
The Clinical Pharmacist is an integral part of the pharmacy management team and will work to drive pharmacy initiatives and clinical programs within the Medi-Cal, Medi-Cal Whole-Child Model, Medicare and Program for All-Inclusive Care for the Elderly (PACE) lines of business. The incumbent will research, develop, update drug utilization management strategies and work to promote clinically appropriate prescribing practices, which adhere to formulary, regulatory guidelines and national clinical practice guidelines. The incumbent will interact frequently and independently with plan members, prescribers, pharmacies, collaborative care team members and with the Pharmacy Benefit Manager (PBM). General duties will include participation in clinical programs, development of drug utilization criteria, review of prior authorizations and appeals and interface with plan members and prescribers to discuss drug therapy.
Position Information:
Department: Pharmacy Management
Pay 58-68/hour
Duties & Responsibilities:
95% 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. Proactively 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 such as Medication Therapy Management (MTM), Transitions of Care (TOC), interdisciplinary care teams and PACE.
Assists the Pharmacy Director and the Manager of Clinical Pharmacists 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 policies and procedures. Update pharmacy policies and develops 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 Manager of Clinical Pharmacists and within Medical Management (e.g., with data manager, case managers, etc.) on various data integration and 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 as part of polypharmacy program. Serves as the plan representative for state fair hearings. Resolves complaints, grievances and appeals.
5% - Other
Completes other duties and projects as assigned.
Company DescriptionCross Country Workforce Solutions Group (CCWSG) is a human resource, consulting and talent acquisition firm, specializing in PACE Programs, FQHCs/CHCs, and State Healthcare plans throughout the US. Our national operations center is located in Southern California.
CCWSG provides clinical and non-clinical staffing support to PACE centers across the country; we are the nation’s exclusive provider of non-medical, in-home caregivers for the elderly enrolled in PACE programs. Currently, we have over 3,000 caregivers supporting patients in their homes through PACE.
We are a part of the Cross Country Healthcare family, a market-leading workforce solutions, tech-enabled talent platform, and staffing, recruitment, and advisory firm with almost 40 years of industry experience and insight. We are a full-service partner, combining market expertise and services, including contingent staffing, consulting, human capital, management solutions, recruitment process outsourcing, vendor management, and direct hiring.
Cross Country Workforce Solutions Group (CCWSG) is a human resource, consulting and talent acquisition firm, specializing in PACE Programs, FQHCs/CHCs, and State Healthcare plans throughout the US. Our national operations center is located in Southern California. CCWSG provides clinical and non-clinical staffing support to PACE centers across the country; we are the nation’s exclusive provider of non-medical, in-home caregivers for the elderly enrolled in PACE programs. Currently, we have over 3,000 caregivers supporting patients in their homes through PACE. We are a part of the Cross Country Healthcare family, a market-leading workforce solutions, tech-enabled talent platform, and staffing, recruitment, and advisory firm with almost 40 years of industry experience and insight. We are a full-service partner, combining market expertise and services, including contingent staffing, consulting, human capital, management solutions, recruitment process outsourcing, vendor management, and direct hiring.