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Job Description
(As-Needed) Clinical Pharmacist
CalOptima
Position Information:- Department: Pharmacy Management
- Salary Grade: 316 - $120,881 - $193,410 ($58.12 - $92.9856)
- Work Arrangement: Full Telework
- Work Schedule: 16 hours per week
- Expected Assignment Duration: Until September 30, 2026 (subject to change)
Submission Information:- The deadline to be guaranteed full review of your submission is due by June 9, 2026 by 9:00 p.m. PST. This position will remain open for a minimum of seven (7) days, but may be extended if a lack of qualified applicants are received or if we are hiring multiple positions.
Duties & Responsibilities:- 95%% - Pharmacy Management
- Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
- Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.
- Generates and analyzes claims and utilization reports to track general trends in drug utilization and to identify potential targeted utilization management activities.
- Develops and updates drug utilization criteria.
- Develops and maintains contacts and relationships with providers key to successful interaction and intervention activities.
- Participates in medication review, disease state management and other clinical quality improvement programs such as Stars and Healthcare Effectiveness Data and Information Set (HEDIS) Quality Improvement Programs, Medication Therapy Management (MTM), interdisciplinary care teams and PACE.
- Assists the Pharmacy Director and the Manager of Clinical Pharmacists in the preparation of drug monographs and utilization reports for the Pharmacy and Therapeutics committee.
- Utilizes clinical and regulatory guidelines in the review of drug prior authorization and appeals requests.
- Adheres to regulatory compliance and quality guidelines as well as CalOptima Health's policies and procedures.
- Updates CalOptima Health's pharmacy policies and develops new policies and procedures when needed.
- Works with management to recommend, develop and implement target drug utilization intervention programs and other Drug Utilization Review/Drug Utilization Evaluation (DUR/DUE) activities.
- Works with the Manager of Clinical Pharmacists and within Medical Management (e.g., with data manager, case managers, etc.) on various data integration, disease management and outcomes projects.
- Reviews members' medication profiles and makes recommendations to health care providers based on evidence-based medicine and national guidelines for disease management as part of CalOptima Health's polypharmacy program.
- Serves as the plan representative for state fair hearings.
- Resolves complaints, grievances and appeals.
- 5%% - Other
- Completes other duties and projects as assigned.
Minimum Qualifications:- Doctor of Pharmacy degree PLUS current knowledge and expertise in clinical pharmacology and disease states required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.
Preferred Qualifications:- Experience in pharmacy practice or residency in pharmacy practice.
- Centers for Medicare & Medicaid Services (CMS), Department of HealthCare Services (DHCS), Department of Managed Health Care (DMHC) and/or National Committee for Quality Assurance (NCQA) audit experience.
- Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Chinese, Farsi, Korean, Russian, Spanish, Vietnamese).
Required Licensure / Certifications:- A current, valid and unrestricted California state registered pharmacist license required.
Knowledge & Abilities:- Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds.
- Work independently and exercise sound judgment.
- Communicate clearly and concisely, both orally and in writing.
- Work a flexible schedule; available to participate in evening and weekend events.
- Organize, be analytical, problem-solve and possess project management skills.
- Work in a fast-paced environment and in an efficient manner.
- Manage multiple projects and identify opportunities for internal and external collaboration.
- Motivate and lead multi-program teams and external committees/coalitions.
- Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.
Physical Requirements (With or Without Accommodations):- Ability to visually read information from computer screens, forms and other printed materials and information.
- Ability to speak (enunciate) clearly in conversation and general communication.
- Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.
- Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.
- Lifting and moving objects, patients and/or equipment 10 to 25 pounds
Work Environment:
If located at the 500, 505 Building or a remote work location:- Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.
- There are no harmful environmental conditions present for this job.
- The noise level in this work environment is usually moderate.
If located at PACE:- Work is typically indoors in a clinical setting serving the frail and elderly.
- There may be harmful or hazardous environmental conditions present for this job.
- The noise level in this work environment is usually moderate to loud.
If located in the Community:- Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.
- Employee will occasionally work outdoors in varied temperatures.
- There may be harmful or hazardous environmental conditions present for this job.
- The noise level in this work environment is usually moderate to loud.
CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics.
If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability.
To apply, please visit: https://jobs.caloptima.org/jobs/as-needed-clinical-pharmacist-505-city-parkway-west-california-united-states
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ABOUT THE COMPANY
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CalOptima
Show moreOur motto and programs
“Better. Together.” is our motto, and it means that by working together, we can make things better — for our members and community. As a public agency, CalOptima was founded by the community as a County Organized Health System that offers health insurance programs for low-income children, adults, seniors and people with disabilities. As Orange County’s single largest health insurer, we provide coverage through four major programs:
Medi-Cal
California’s Medicaid Program for low-income children, adults, seniors and people with disabilities, offering comprehensive health care coverage
OneCare Connect Cal MediConnect Plan
Medicare-Medicaid Plan that combines Medicare and Medi-Cal benefits and adds worldwide emergency care, dental care, vision care and transportation to medical services at no extra cost
OneCare (HMO SNP)
Medicare Advantage Special Needs Plan for seniors and people with disabilities who qualify for both Medicare and Medi-Cal
Program of All-Inclusive Care for the Elderly
PACE for frail older adults, providing a full range of health and social services so seniors can remain living in the community
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