Clinical Pharmacist - Managed Care & HEDIS Excellence

Vivant Health; Sacramento (CA); On-site; USD 120,000 - 160,000; Full time

Benefits offered by this job

Health insurance

Job summary

Vivant Health in Sacramento, CA seeks a Clinical Pharmacist to support managed pharmacy operations across Medicare Advantage and Medi-Cal, focusing on utilization management, PA, formulary management, MTM, and cost optimization.

You will collaborate with plans, providers, and care teams to improve access, quality, and STAR/CAHPS outcomes, while ensuring compliant, evidence-based medication use.

Qualifications

• 3–5 years of clinical pharmacy experience in managed care, health plan operations, or population health management.
• Experience supporting Medicare Advantage, Medi-Cal, and Medicare Part D.
• Expertise in utilization management, prior authorization, formulary management, MTM, and evidence-based clinical review.
• Experience supporting P&T Committee activities, including formulary evaluation and assessment of therapeutic alternatives.
• Working knowledge of CMS, DHCS, NCQA, URAC regulatory and accreditation requirements.
• Knowledge of HEDIS measures, Medicare Star Ratings, CAHPS, and value-based care initiatives.

Responsibilities

• Utilization Management & Medication Review: Review PAs and specialty requests using Medi-Cal, Medicare, and Vivant Health criteria; apply formulary requirements and support coverage determinations.
• Quality Improvement & Population Health: Support HEDIS/Star measures and collaborate with care teams on targeted interventions; participate in performance reporting.
• Compliance, Program Oversight & Cost Management: Maintain CMS/NCQA compliance; support audits and utilization documentation.
• Collaboration & External Partnerships: Act as pharmacy resource; collaborate with providers and health plans on prior authorizations and coverage criteria.
• Other Functions: Uphold company policies, participate in educational opportunities, and maintain professional standards.

Skills

Utilization management

Prior authorization

Formulary management

MTM

Pharmacy claims analytics

Population health

Communication

Analytical skills

Regulatory compliance

Education

PharmD degree

California pharmacist license

Board certification (BCPS/BCACP)

Tools

Pharmacy information systems

Microsoft Office

Job description

Vivant Health in Sacramento, CA seeks a Clinical Pharmacist to support managed pharmacy operations across Medicare Advantage and Medi-Cal, focusing on utilization management, PA, formulary management, MTM, and cost optimization.

You will collaborate with plans, providers, and care teams to improve access, quality, and STAR/CAHPS outcomes, while ensuring compliant, evidence-based medication use.