Medicare Advantage Staff Pharmacist
UCLA Health
Description
As our Medicare Advantage Staff Pharmacist, supporting the pharmacy department in managing the Medicare Advantage Part D Prescription Benefit. You'll ensure compliance with Medicare regulations, optimize operational efficiency, and maintain financial and clinical quality.
In this role, you will:
* Oversee delegated entities and ensure compliance
* Manage claims processing and formulary utilization
* Analyze drug utilization trends to identify cost-saving opportunities
* Coordinate member communications
* Collaborate closely with delegated medical groups
* Lead initiatives to improve medication adherence and STAR ratings
* Ensure timely and accurate Medicare reporting
* Support the development of Medicare Part B strategy development
This role serves as a vital pharmacy resource, focusing on PBM coordination and cross-department collaboration as a subject matter expert in Medicare Part D and pharmacy topics.
Salary Range: $86.32/hour-$107.31/hour
Qualifications
We're seeking a dedicated clinical professional with:
+ PharmD degree and current, unrestricted CA Pharmacy License
+ Minimum of 7 years of relevant experience, or 5+ years of experience with residency, required
+ At least 3 years of Medicare Experience, including CMS compliance, required
+ Minimum 3 years of experience in PBM or health plan settings, required
+ 3+ years of experience collaborating with medical groups, required
+ In-depth knowledge of pharmacy supply chain management, including pharmacy networks and specialty pharmacy, required
+ Proven background in pharmacy clinical operations, including prior authorization, appeals, grievances
+ Experience with EPIC EHR functionality
+ Proficient in Microsoft Word and Excel
+ Strong commitment to patient confidentiality and thorough knowledge of HIPAA requirements, required
UCLA Health welcomes all individuals, without regard to race, sex, sexual orientation, gender identity, religion, national origin or disabilities, and we proudly look to each person’s unique achievements and experiences to further set us apart.
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