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Health Net, Inc.

Senior Clinical Pharmacist CA-Sacramento (California Health and Wellness) - Military veterans preferred

Health Net, Inc. - Sacramento, CA

Position Purpose: Define and develop standard and custom formularies for complex or specialized medications for assigned planDevelop clinical criteria for review of complex or specialized medications, recommend plan design changes and communicate recommendations to clients
Monitor and review prior authorization requests for complex or specialized medications
Develop and design clinical edits to adjudicate claims and enhance drug utilization
Analyze pharmacy cost of care, trends, and coordinate the development of appropriate use protocols and guidelines
Set criteria for medication analysis, coordinate reports to clients, meet regulatory reporting requirements for drug utilization review and fraud and abuse reporting
Develop and implement medication therapy management programs. Evaluate program performance, recommend changes and ensure successful implementation of changes
Ensure and evaluate quality controls and implement opportunities for performance improvement
Research drug information to maintain drug knowledge and disease state understanding for application to prior authorization reviews
Provide clinical guidance and support to various departments and address clinical related questionsEducation/Experience: Bachelor\u2019s degree or advanced degree (Pharm.D., M.S.) in pharmacy. 4 years of mail order, retail, hospital, managed care pharmacy experience or pharmacy residency program experience.Licenses/Certifications: Current state\u2019s Pharmacist license with no restrictionsCentene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

6 days 21 hours ago

Health Net, Inc.

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Senior Clinical Pharmacist CA-Sacramento (California Health and Wellness) - Military veterans preferred Health Net, Inc. - Sacramento, CA, United States

   

Location: Sacramento, CA

Company Profile:
Health Net's mission is to help people be healthy, secure and comfortable.