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Job description
Clinical Pharmacist
Department: Pharmacy
Location: Sacramento (Onsite/Hybrid)
Schedule: Full-Time | Exempt
Compensation: $140,000 - $160,000 annually
Travel: Minimal, as needed
"Purpose that inspires. Impact that improves lives. Join us in building healthier communities."
Western Health Advantage
Make an Impact Where It Matters Most
At Western Health Advantage, we are committed to delivering high-quality, clinically sound, and member-focused healthcare solutions. As a Clinical Pharmacist supporting Prior Authorization Operations, you will play a vital role in ensuring safe, effective, and compliant medication use across our member population.
This role offers a unique opportunity to apply your clinical expertise in a managed care environment—supporting coverage determinations, influencing formulary strategy, and collaborating with cross-functional teams to improve outcomes and optimize care.
What You’ll Do
Deliver Clinical Excellence
You will perform comprehensive clinical reviews of prior authorization (PA), exception, and appeal requests—leveraging clinical guidelines, drug information resources, and regulatory standards to ensure accurate and timely coverage determinations.
Ensure Regulatory Compliance
You will apply and uphold all applicable regulatory and accreditation standards (NCQA, DMHC, Board of Pharmacy, Knox-Keene), ensuring that all decisions and processes meet compliance requirements and organizational policies.
Collaborate & Communicate
You will serve as a clinical resource to internal teams and network providers—clearly communicating decision rationale, supporting appeals, and contributing to pharmacy-related initiatives across the organization.
Support Formulary & Utilization Management
You will contribute to formulary development and maintenance, provide clinical input on PBM strategies and P&T committee outputs, and support updates to prior authorization criteria and preferred drug lists.
Drive Operational Excellence
You will participate in workflow optimization, quality improvement initiatives, and system enhancements—helping to improve efficiency, reduce errors, and strengthen overall pharmacy operations.
Key Responsibilities
Review and evaluate prior authorization requests for outpatient and specialty medications
Conduct drug utilization reviews in compliance with regulatory standards
Research and apply current clinical data and therapeutic guidelines
Support appeals and grievance processes related to pharmacy benefit determinations
Collaborate with PBM partners on formulary management and drug product updates
Monitor and update formulary listings and PA criteria
Analyze pharmacy trends and support cost-of-care initiatives
Provide education to providers and internal stakeholders on pharmacy programs
Assist with regulatory audits (DMHC, NCQA) and accreditation activities
Support training, documentation, and process development initiatives
Participate in system testing, validation, and operational readiness efforts
Provide cross-coverage support and ensure timely case completion
Qualifications
Doctor of Pharmacy (PharmD) or equivalent required
Active, unrestricted California Pharmacist license in good standing
Minimum 4 years of pharmacy experience (retail, hospital, or mail order)
2+ years of managed care, PBM, or health plan experience preferred
Experience with prior authorization review and utilization management
Familiarity with formulary management and P&T committee processes preferred
Proficiency in evaluating clinical literature and drug databases (e.g., UpToDate, DrugDex, NCCN)
Strong computer skills including Microsoft Office and pharmacy systems
Why Western Health Advantage
Mission-Driven Work
Contribute to improving healthcare quality and access across the communities we serve
Collaborative Culture
Work alongside experienced clinicians and professionals in a supportive environment
Professional Growth
Expand your expertise in managed care pharmacy, formulary strategy, and clinical operations
Meaningful Impact
Play a key role in ensuring safe, effective, and cost-conscious medication
If you are a clinically driven pharmacist who thrives in a collaborative, fast-paced environment and is passionate about improving patient outcomes through thoughtful, evidence-based decisions, we encourage you to apply and be part of Western Health Advantage.
Worksite address
sacramento, CA, 95828, US
Who can apply
Review the original listing for work authorization, qualifications and employer requirements.