Clinical Pharmacist - Care Management & UM Expert

Paycom - ATS; Sacramento (CA); On-site; USD 155,000 - 170,000; Full time

Job summary

Paycom - ATS is seeking an experienced pharmacist to oversee utilization review and benefit administration within a managed care setting in California. The role focuses on ensuring appropriate, cost-effective medication use, MTM and transitions of care for high-risk members, and supporting coverage determinations.

The ideal candidate holds a PharmD, is licensed in California, and has 3–5 years of clinical pharmacy experience, with knowledge of Medi-Cal and Medicare Part D.

Qualifications

• Minimum 3–5 years of clinical pharmacy experience.
• Experience in managed care, health plan operations, or population health management preferred.
• Knowledge of Medi-Cal and Medicare Part D programs and regulations.

Responsibilities

• Conduct daily review of outpatient requests using applicable criteria to ensure cost-effective medication use.
• Support coverage determinations, appeals, and documentation as needed.
• Perform MTM, CMRs, and TMRs for high-risk or prioritized members.
• Conduct transitions of care and post-discharge reconciliation for select patients.
• Assist in QA, population health initiatives, and performance reporting.

Skills

Clinical pharmacy

Managed care

Medicare/Medicaid (Medi-Cal)

MTM & CMRs

Pharmacy analytics

Education

PharmD (Doctor of Pharmacy)

CA Pharmacist license

Board certification (BCPS/BCACP)

Tools

Pharmacy information systems

Electronic Health Records

Job description

Paycom - ATS is seeking an experienced pharmacist to oversee utilization review and benefit administration within a managed care setting in California. The role focuses on ensuring appropriate, cost-effective medication use, MTM and transitions of care for high-risk members, and supporting coverage determinations.

The ideal candidate holds a PharmD, is licensed in California, and has 3–5 years of clinical pharmacy experience, with knowledge of Medi-Cal and Medicare Part D.