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Medi-Cal Formulary Pharmacist

Date: Oct 13, 2021

Location: West Sacramento, CA, US, 95605-1630

Company: Gainwell Technologies LLC

The Insurance/Healthcare job family contains positions associated with providing consultancy utilizing knowledge and expertise on insurance and healthcare. Develops and implements general insurance and health policies in accordance with state and federal laws. Provides expertise to investigate and adjudicate claim characteristics that do not match policy provisions. Advises and works with clients, medical review team, and project teams on various pharmacy and medical issues related to insurance and healthcare programs.

 

Responsibilities:

  • Update and maintain the formulary.
  • Ensure formulary data and pricing conforms to current policies and procedures.
  • Proactively assess and analyze changes in the formulary and recommend drug data and pricing updates.
  • Provide clinical review support services and resolution of provider issues.
  • Review and implement policies and make recommendations as necessary.
  • Provide expertise and guidance to support system development projects.
  • Provide general medical review service and reporting.
  • Review provider publications.
  • Ability to manage multiple projects, tasks, and requests with minimal or no supervision.

 

Education and Experience Required:

  • Graduate of an accredited College or School of Pharmacy with a baccalaureate degree in pharmacy (BS Pharmacy) and/or Doctor of Pharmacy (PharmD) degree.
  • Minimum of 3 years previous experience as a pharmacy consultant for a government of private sector healthcare. payor; or 1 year of MMIS experience in a state providing expertise and assistance for pharmacy review.
  • Current, unrestricted registered pharmacist license in the State of California.
  • Not under suspension from Medicare, Medicaid, practice in California, and not previously sanctioned for fraud or abuse.

 

Knowledge and Skills:

  • Experience with expert knowledge of and government insurance programs.
  • Extensive level of understanding and application of healthcare related technologies.
  • Excellent written, verbal, and presentation skills.
  • Knowledge of formulary maintenance processes.
  • Understanding of First Databank database.
  • Familiarity with different drug price types.
  • Proficiency in Microsoft Office Suite with emphasis on Microsoft Excel and Microsoft Access.
  • Experience in working with large datasets.
  • Ability to adapt when faced with unexpected challenges or roadblocks.
  • Detail-oriented and self-motivated with excellent time management and organizational skills.
  • Team-player who can also work independently.