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About Clever Care Health Plan

Clever Care Health Plan is a newly founded Medicare Advantage health plan serving Medicare beneficiaries in Southern California. Our employees are passionate in providing best services to our members and healthcare providers. Our three office locations are in Arcadia (Los Angeles County), Huntington Beach (Orange County) and New York City.

Job Summary

This position is responsible for maintaining and supporting the Medicare formulary and providing clinical and economic data necessary to make formulary decisions. This position acts as a pharmacy resource for network physicians, health plan members, medical services, care management, and member service staffs as well as other internal partners. Assists in performing all CMS mandated quality and compliance activities. Serves as a pharmacy topic educator and training resource to Medicare health plan departments and personnel.

Functions and Job Responsibilities

  • Provides and assists with the management of pharmacy services to Medicare health plan members that is consistent with acceptable standards of pharmacy practice and CMS Medicare Part D regulations and guidance.
  • Collaborate on population health initiatives focusing on improving star ratings, optimizing medication adherence, reducing costs, and improving management of chronic conditions, such as Diabetes and Hypertension
  • Collaborate with primary care providers and medical directors on cases of complex medication management.
  • Assists in defining, implementing and managing Medicare health plan pharmacy programs including the medication therapy and drug utilization management.
  • Directly interfaces with Medicare members, and network providers concerning pharmacy issues and programs. Designs and delivers staff/community educational programs and provides individual medication counseling, if appropriate.
  • Produces pharmacy utilization reports as well as clinical and economic data to the health plan to assist in pharmacy benefit utilization analysis.
  • Directly interfaces with the quality team by designing and monitoring tactics to improve pharmacy related STARs measures, medication reconciliation. 
  • Conducts audits and produces reports that can be utilized by the care management, quality and compliance departments to evidence quality pharmacy services and meets Medicare requirements.
  • Work with Medical Directors and the Chief Medical Officer to identify opportunities to innovate and improve medical care.
  • Applies the principles of continuous quality improvement consistent with job expectations. Incorporates quality improvement principles into other activities and projects (i.e. data collection, documentation). Develops criteria for drug use evaluations, medication use indicators and disease-based evaluations.
  • May be assigned to create data extracts of the pharmacy claims system and support ad hoc report requirements for health plan pharmacy utilization management and audit functions.
  • Performs all functions according to established policies, procedures, regulatory and accreditation requirements, as well as applicable professional standards. Provides all customers with an excellent service experience by consistently demonstrating our core and leader behaviors each and every day.

Education and Experience

  • Must possess a degree in Pharmacy (advanced degree preferred) from an accredited College of Pharmacy.
  • Requires managed care/health plan and/or pharmacy benefits experience.
  • Medicare Part D experience highly desirable and preferred
  • Additional related education and/or experience preferred.
  • Requires pharmacy licensure in state worked.

Knowledge, Skills, and Abilities

  • Requires effective human relations and verbal/written communication skills and the ability to work collaboratively with community based practitioners and the senior population is essential. An understanding of the interrelationships of health plan pharmacy components, members, and providers is required.
  • Proficiency with PC based productivity tools required. Needs analytical ability to support decision making; organizational ability to manage multiple tasks and projects by established deadlines.
  • Geriatric certification is a plus.

Physical & Working Environment

Typical Physical Demands.
Position requires a great amount of sitting and standing. Some lifting, stooping, bending, or reaching is required. May require lifting up to 15‐30 pounds. Requires manual dexterity sufficient to operate a computer, calculator and telephone. Requires normal range of hearing and vision. Requires the ability to type and file.

Typical Working Conditions.
Work is performed in an office environment and/or remotely. The job involves frequent contact with staff and public. Work may be stressful at times. May occasionally work some irregular hours.

Apply for the Director of Pharmacy position at Clever Care Health Plan