Pharmacist

ACTalent; Sacramento (CA); Hybrid; USD 101,000 - 110,000; Full time

Benefits offered by this job

Medical benefits

Dental & Vision benefits

Critical Illness, Accident & Hospital

401(k) plan

Life Insurance

Disability insurance

HSA

Transportation benefits

Employee Assistance Program

Paid time off

Job summary

ACTalent is seeking an experienced Clinical Pharmacist to support managed care operations with emphasis on utilization management, prior authorization review, formulary management, and MTM. The role collaborates with providers, health plans, care teams, and stakeholders to promote appropriate medication use, improve outcomes, and manage costs in a health-plan environment.

Ideal candidates bring CA Pharmacist license, PharmD, 3–5 years of clinical pharmacy experience in managed care, and strong

Qualifications

• Doctor of Pharmacy (PharmD) degree from an accredited program.
• Active California Pharmacist License in good standing.
• 3–5 years of clinical pharmacy experience.
• Experience in managed care, health plan operations, PBM, Medicare Advantage, Medi-Cal, Medicaid, or population health settings.
• Experience with: Utilization Management (UM)
• Prior Authorization (PA)
• Formulary Management
• Medication Therapy Management (MTM)
• Clinical guideline review
• Strong analytical and problem-solving skills.
• Excellent verbal and written communication skills.
• Proficiency with Microsoft Office and clinical/pharmacy information systems.

Responsibilities

• Review outpatient prior authorization requests and specialty medication requests using established clinical guidelines and coverage criteria.
• Evaluate medication appropriateness, formulary compliance, step therapy requirements, and therapeutic alternatives.
• Support coverage determinations, appeals, and clinical documentation processes.
• Conduct MTM, CMRs, TMRs, medication reconciliation, and adherence interventions.
• Review high-cost therapies, specialty medications, and pharmacy claims data to identify utilization and cost-management opportunities.
• Support transitions of care and medication optimization initiatives.
• Support medication-related quality initiatives, including HEDIS and Medicare Star Ratings measures.
• Collaborate with Quality, Care Management, and Population Health teams to improve medication adherence and health outcomes.
• Participate in quality improvement projects, performance monitoring, and program evaluations.
• Maintain compliance with regulatory, accreditation, and organizational requirements.
• Support pharmacy audits, accreditation activities, and UM documentation standards.
• Assist in identifying opportunities to improve medication effectiveness, safety, and cost-efficiency.
• Review cases for potential fraud, waste, and abuse.
• Serve as a pharmacy SME for clinical and operational teams.
• Partner with providers and health plans regarding prior authorizations, formulary management, utilization reviews, and medication-related policies.
• Participate in interdisciplinary meetings, case reviews, and provider education initiatives.
• Provide training and education regarding pharmacy programs, utilization criteria, and regulatory updates.

Skills

Pharmacist license

Clinical pharmacy experience

Managed care exposure

UM

PA

Formulary management

MTM

Clinical guidelines

Communication skills

MS Office & pharmacy systems

Education

PharmD

Job description

Pharmacist Clinical Pharmacist (Managed Care / Utilization Management)

Location: Sacramento/Hybrid Job Type: Full-Time

Position Summary

We are seeking an experienced Clinical Pharmacist to support managed pharmacy operations with a focus on utilization management, prior authorization review, formulary management, medication therapy management (MTM), and specialty pharmacy cost optimization . This role partners closely with providers, health plans, care management teams, and other stakeholders to promote appropriate medication use, improve member outcomes, support quality initiatives, and manage total cost of care. The ideal candidate will have experience within a health plan, managed care, IPA, PBM, Medicare Advantage, or Medi-Cal environment and possess strong knowledge of pharmacy benefit management, regulatory requirements, and population health strategies.

Essential Responsibilities

Utilization Management & Clinical Review

• Review outpatient prior authorization requests and specialty medication requests using established clinical guidelines and coverage criteria.
• Evaluate medication appropriateness, formulary compliance, step therapy requirements, and therapeutic alternatives.
• Support coverage determinations, appeals, and clinical documentation processes.
• Conduct medication therapy management (MTM), comprehensive medication reviews (CMRs), targeted medication reviews (TMRs), medication reconciliation, and adherence interventions.
• Review high-cost therapies, specialty medications, and pharmacy claims data to identify utilization and cost-management opportunities.
• Support transitions of care and medication optimization initiatives.

Quality & Population Health

• Support medication-related quality initiatives, including HEDIS and Medicare Star Ratings measures.
• Collaborate with Quality, Care Management, and Population Health teams to improve medication adherence and health outcomes.
• Participate in quality improvement projects, performance monitoring, and program evaluations.

Compliance & Program Oversight

• Maintain compliance with applicable regulatory, accreditation, and organizational requirements.
• Support pharmacy audits, accreditation activities, and utilization management documentation standards.
• Assist in identifying opportunities to improve medication effectiveness, safety, and cost-efficiency.
• Review cases for potential fraud, waste, and abuse.

Provider & Health Plan Collaboration

• Serve as a pharmacy subject matter expert for clinical and operational teams.
• Partner with providers and health plans regarding prior authorizations, formulary management, utilization reviews, and medication-related policies.
• Participate in interdisciplinary meetings, case reviews, and provider education initiatives.
• Provide training and education regarding pharmacy programs, utilization criteria, and regulatory updates.

Qualifications

Required

• Doctor of Pharmacy (PharmD) degree from an accredited program.
• Active California Pharmacist License in good standing.
• Minimum 3-5 years of clinical pharmacy experience.
• Experience in managed care, health plan operations, PBM, Medicare Advantage, Medi-Cal, Medicaid, or population health settings.
• Experience with: Utilization Management (UM)
• Prior Authorization (PA)
• Formulary Management
• Medication Therapy Management (MTM)
• Clinical guideline review
• Strong analytical and problem-solving skills.
• Excellent verbal and written communication skills.
• Proficiency with Microsoft Office and clinical/pharmacy information systems.

Preferred

• Board Certification (BCPS, BCACP, or related specialty certification).
• Experience supporting Pharmacy & Therapeutics (P&T) Committees.
• Knowledge of Medicare Part D, HEDIS, Medicare Star Ratings, value-based care models, and population health management.
• Experience evaluating pharmacy claims data, utilization trends, and specialty pharmacy costs.

What We're Looking For

Successful candidates will demonstrate:

• Strong clinical judgment and decision-making skills.
• Knowledge of managed care pharmacy and health plan operations.
• Ability to interpret and apply evidence-based clinical guidelines.
• Experience collaborating with providers, health plans, and interdisciplinary teams.
• Commitment to improving quality, access, and medication outcomes.
• Ability to thrive in a fast-paced, collaborative environment

Job Type & Location

This is a Contract to Hire position based out of Sacramento, CA.

Pay and Benefits

The pay range for this position is $73.00 - $80.00/hr. Individual compensation offered for this position within this range will depend on many factors, including qualifications, skills, relevant experience, job knowledge, geographic location, internal equity, and other pertinent job-related factors. Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following:

• Medical, dental & vision
• Critical Illness, Accident, and Hospital
• 401(k) Retirement Plan Pre-tax and Roth post-tax contributions available
• Life Insurance (Voluntary Life & AD&D for the employee and dependents)
• Short and long-term disability
• Health Spending Account (HSA)
• Transportation benefits
• Employee Assistance Program
• Time Off/Leave (PTO, Vacation or Sick Leave)

Application Deadline

This position is anticipated to close on Nov 14, 2026.

Workplace Type

This is a hybrid position in Sacramento,CA.

The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please email [e-mail] for other accommodation options.

San Francisco Fair Chance Ordinance:
Pursuant to the San Francisco Fair Chance Ordinance, for all positions located in the city and county of San Francisco, we will consider for employment qualified applicants with arrest and conviction records.

Massachusetts Lie Detector:
It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.

Use of Artificial Intelligence (AI):
We may use Artificial Intelligence (AI) to support parts of our hiring process, including sourcing, screening, and evaluating candidates. AI helps assess applications and qualifications, but final decisions are made by our hiring team. By applying, you acknowledge and agree that your application may be reviewed using AI tools.