Clinical Pharmacist: Utilization Review & Improvement

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

Job summary

Paycom - ATS, in Sacramento, seeks a Pharmacist to manage core utilization review functions and support quality initiatives across Medi-Cal and Medicare. The role focuses on practical, high-value clinical reviews and collaboration with health plans and providers on medication-related issues.

Responsibilities include prior authorization review, medication management, and performance improvement, with emphasis on efficient case review and targeted outreach to optimize patient outcomes and

Qualifications

• 3–5 years of clinical pharmacy experience.
• Experience in managed care, health plan operations, or population health management preferred.
• Active California pharmacist license and PharmD degree required.

Responsibilities

• Conduct daily review of outpatient PAs, TARs, and specialty drug requests using Medi-Cal, Medicare criteria.
• Apply formulary guidelines and evidence-based standards to ensure cost-effective use.
• Provide therapeutic alternatives and recommendations for non-formulary requests.
• Support coverage determinations, appeals, and documentation as needed.
• Perform MTM, CMRs, TMRs on targeted, high-risk members.
• Coordinate transitions of care and post-discharge reconciliation for high-risk cases.
• Collaborate with care management and health plans to optimize patient outcomes.

Skills

Clinical pharmacy

Managed care

Population health

MTM

Prior authorization

Education

PharmD degree

California pharmacist license

Tools

Pharmacy information systems

Electronic health records

Job description

Paycom - ATS, in Sacramento, seeks a Pharmacist to manage core utilization review functions and support quality initiatives across Medi-Cal and Medicare. The role focuses on practical, high-value clinical reviews and collaboration with health plans and providers on medication-related issues.

Responsibilities include prior authorization review, medication management, and performance improvement, with emphasis on efficient case review and targeted outreach to optimize patient outcomes and