Clinical Pharmacist: UM, P&T & Formulary Strategy

Western Health Advantage; Sacramento (CA); On-site; USD 118,000 - 140,000; Full time

Job summary

Western Health Advantage is seeking a Clinical Pharmacist to perform clinical reviews of UM cases, issue prior authorizations, and support formulary development and P&T activities. The role emphasizes adherence to NCQA, DMHC, and Board of Pharmacy regulations, with collaboration across provider networks and internal teams.

You will oversee drug policy updates, participate in quality improvement programs, and communicate cost-effective prescribing options to Medical Groups while maintaining

Qualifications

• Must hold a PharmD or equivalent and California license.
• Must be able to meet California pharmacist licensure requirements and maintain it throughout employment.
• Pharmacy residency training is preferred.
• Experience with formulary management and PA criteria is desirable.
• Proficiency in evaluating drug literature and clinical data.

Responsibilities

• Develop and update clinical pharmacy UM criteria for outpatient and office medications.
• Monitor and review prior authorization requests for medications in compliance with regulations.
• Research drug information to maintain current knowledge for PA reviews.
• Analyze pharmacy cost of care and develop use protocols and guidelines.
• Support the P&T Committee with drug reviews, criteria updates, and record keeping.
• Participate in clinical quality improvement programs with Medical Management and PBM teams.
• Educate Medical Groups and Prescribers on pharmacy program initiatives and cost-effective options.
• Collaborate with PBM to manage drug products and formulary documentation.
• Audit and update formulary drug lists and PA criteria websites.
• Precept or participate with pharmacy students during rotations.
• Assist accreditation audits with DMHC and NCQA as needed.
• Provide clinical guidance to internal departments requiring pharmacist interventions.
• Develop pharmacy policy procedures and training materials.
• Ensure coverage during holidays and weekends to meet regulatory requirements.
• Perform other duties as assigned by leadership.

Skills

Drug literature evaluation

Clinical pharmacology

PBM/Managed care

Prior authorization criteria

Data analysis

Education

Doctor of Pharmacy (PharmD)

California pharmacist license

Pharmacy Residency preferred

Tools

UpToDate

DrugDex

Clinical Pharmacology

Job description

Western Health Advantage is seeking a Clinical Pharmacist to perform clinical reviews of UM cases, issue prior authorizations, and support formulary development and P&T activities. The role emphasizes adherence to NCQA, DMHC, and Board of Pharmacy regulations, with collaboration across provider networks and internal teams.

You will oversee drug policy updates, participate in quality improvement programs, and communicate cost-effective prescribing options to Medical Groups while maintaining