Clinical Pharmacist

The Alliance is an award-winning regional non-profit health plan, established in 1996, with over 19 years of successful operation. Using the State’s County Organized Health System (COHS) model, we currently serve 328,486 members in Santa Cruz, Monterey and Merced counties. We work in partnership with our contracted providers to promote prevention, early detection and effective treatment, and improve access to quality health care for those we serve.

Under direction, this position: 1. Ensures implementation of the Alliance Formulary; 2. Performs pharmacy utilization review using applicable policies, develops cost-effective pharmacy measures and advises on claims issues; 3. Provides liaison with the pharmaceutical and medical communities relative to prescription of medications; and 4. Performs other duties as assigned.

1. Ensures implementation of the Alliance Formulary with duties including but not limited to: * Reviewing and authorizing pharmacy authorizations; * Reviewing issues associated with the Drug Formulary; and * Maintaining the Drug Formulary and making recommendations for changes, as appropriate including ePocrates and Pharmacy Benefits Manager (PBM) formulary template. 2. Performs pharmacy utilization review, develops cost-effective pharmacy measures and advises on claims issues, with duties including but not limited to: * Developing and maintaining protocols for Treatment Authorization Request (TAR) authorization criteria; * Interfacing with PBM; * Assisting in resolution of disputed or questionable claims relative to medications; * Monitoring use and abuse of prescription drugs within the program through analysis of periodic statistical data and other information, including Fraud Waste Abuse Prevention (FWAP) reports, using both PBM and health plan reporting tools. * Advising on the appropriate pricing of drug and supplies claims; * Preparing Utilization Review (UR) reports; * Ensuring quality of pharmacy services through UR, review of medical records and provider education; * Advising on cost-effective delivery of pharmacy services (e.g., generic drug contract, rebate, Code I drugs, provider education, etc.); * Making recommendations on program changes relative to covered pharmacy services; * Participating in Care Management initiatives; and * Assisting Pharmacy Manager in maintaining list of internal authorization criteria. 3. Provides liaison with the pharmaceutical and medical communities with duties including but not limited to: * Providing resource for issues related to pharmaceuticals and related supplies; * Responding to provider and pharmaceutical supplier inquiries related to program benefits; * Attending Pharmacy and Therapeutics Committee and other committees as assigned; and * Assisting, as requested, in responding to Federal and State program evaluations and audits. 4. Performing other duties as assigned.

**Job Specific Knowledge , Skills and Abilities:** * Working knowledge of Medi-Cal and prepaid health programs; * Working knowledge of computerized drug programs; * Working knowledge of drug utilization; * Working knowledge of drugs and supplies required in the operation of a pharmacy; * Basic knowledge of principles of statistics, preferred; * Ability to maintain accurate records; and * Ability to use MS Word and Excel required. **Alliance Standard Knowledge, Skills and Abilities:** * Ability to communicate effectively, both orally and in writing; * Ability to establish and maintain effective and cooperative working relationships with Alliance staff and others contacted in the course of the work; * Ability to assume responsibility and exercise good judgment in making decisions within the scope of authority of the position; * Ability to think and work effectively under pressure and accurately complete tasks within established times; * Ability to prioritize and meet deadlines; * Ability to maintain confidentiality; and * Valid California Driver License, transportation and automobile liability insurance in limits acceptable to the Alliance. **Work Environment and Physical Demands:** * Ability to sit in front of and operate a video display terminal for extended periods of time; * Ability to stand, bend, reach overhead, lift, carry or move objects of varying size weighing up to 10 pounds. **All Alliance Employees are Expected to:** * Comply with all Alliance safety requirements; * Adhere to all Alliance policies and procedures. The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive of the tasks that an employee may be required to perform. The Alliance reserves the right to revise this job description at any time.