Clinical Pharmacist

Provides pharmacotherapy expertise in support of the Pharmacy and Therapeutics (P&T) Committee, and drug formulary, prior authorization, drug utilization review, and physician education programs.

Prior Authorization Process: Perform clinical review of PAs/MRFs.

Pharmacy Review Committee: Prepare for bimonthly or monthly meetings (new drug reviews for CA and Medi-Cal formularies, drug class reviews for CA).

Clinical Pharmacy Program – CPOP, MTM-LTC, Pharmacy Case Review, CMS Star Rating Clinical Initiatives.

HPSM/UOP and HPSM/USC Managed Care Internship: Perform intern teaching/preceptor duties.

Give support for the development and maintenance of an internal Health Plan Drug Formulary for all product lines.

Provide pharmacist support for the drug prior authorization program and review drug treatment authorizations.

Provide clinical pharmacist expertise to the HPSM Clinical Pharmacy Program in the following clinical initiatives and intervention programs such as:

Clinical Pharmacy Outreach Program (CPOP)

MTM Program for Long Term Care Patients

Pharmacy Case Review of High Utilizers, Narcotic Utilizers, Adverse Drug Interaction Reports, Poor Medication Adherence Reports

Clinical Initiatives Related to CMS Part D Plan Star Rating

Help with pharmacy claims adjudication, benefit and formulary problems.

Act as preceptor for pharmacy interns.

Day to Day Duties:

Prior Authorization Process: Perform clinical review of PAs/MRFs.

Pharmacy Appeals Process: perform clinical review of appeals and redetermination requests.

Help with pharmacy claims adjudication, benefit and formulary problems generated from external and internal inquiries.

Act as preceptor for pharmacy interns.

This person must:

Communicate effectively, verbally and in writing.

Proficiently use computers and related software applications.

Provide effective customer service.

Demonstrate sound math, analytical, and problem solving skills.