Clinical Pharmacist Full Time

4 weeks ago

Ontario, Canada HealthCare Talent Full time

The Clinical Pharmacist should demonstrate the ability to participate in multidisciplinary teams to provide comprehensive care to Members through Clinical Programs including Medication Reconciliation, Medication Therapy Management, and other departmental initiatives.




Preparation of medication reconciliation reviews for post-discharge, comprehensive medication reviews (CMRs), and other medication management programs that includes reviewing chart notes, electronic medical records, and/or relevant clinical information within compliance turnaround times and quality standards meeting regulatory requirements as defined by Department of Health Care Services, Center for Medicare & Medicaid Services, California Department of Managed Health Care, and National Committee for Quality Assurance.



Clinical oversight for activities related to the medication therapy management (MTM) programs including targeted medication reviews (TMRs) and comprehensive medication reviews (CMRs), and other related activities for Members, Providers, and pharmacies.


Communicate with Providers and Member (in English and Spanish) providing information and assistance as appropriate.


Communicate with providers (doctor and pharmacy) and members on issues related to the medication reconciliation, medication therapy management, prior authorizations or respective policies and procedures.


Decision prior authorizations according to established treatment protocols, clinical medication criteria, clinical practice guidelines and monographs and within compliance turnaround times and quality standards meeting regulatory requirements as defined by Center for Medicare & Medicaid Services, California Department of Managed Health Care and National Committee for Quality Assurance.


Ensure regulatory reporting requirements and fraud and abuse reporting are met for all clinical and prior authorization operations.


Attend quarterly Pharmacy & Therapeutics meetings to participate in clinical discussions and review. Provider quarterly post Pharmacy & Therapeutics education on updates, new criteria, and pertinent clinical information to the Pharmacy Program Specialist team members.


Perform peer review auditing and quality assurance checks to ensure clinical decision making and clinical recommendations meets the regulatory and company standards.


Actively participate in internal quality improvement process enhancements, LEAN projects, and managing for daily improvement (MDI).




Participate in various pharmacy projects to meet the standards of Healthcare Effectiveness Data and Information Set (HEDIS) and Consumer Assessment of Healthcare Providers and Systems (CAHPS).


Ensure all departmental goals (including, but not limited to turnaround, production expectations, and quality metrics) are met.


Ensure all company’s goals (including, but not limited to the 5 Strategic Priorities: Quality of Care and Service, Access to Care, Practice Transformation, Human Development and Technology and Data Analytics).


Exhibit behavior as referenced in the Handbook (i.e. attendance, dress code, electronic device policy, personal behavior).
















Three (3) or more years of individual or combined experience in pharmacy, hospital, or drug benefit related quality assessment, utilization management and/or provider liaison duties.
Doctor of Pharmacy (Pharm. Professional Licenses


Possession of an active, unrestricted, and unencumbered Registered Pharmacist license issued by the California State Board of Pharmacy.




Drivers License Required
Bilingual (English/Spanish) preferred.

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