Clinical Pharmacy Manager

The Health Plan of San Mateo (HPSM), a managed care health plan, seeks a full time Clinical Pharmacy Manager to lead clinical pharmacy operations and ensures appropriate pharmaceutical utilization at HPSM for all lines of business under the guidance of the Director of Pharmacy. Responsible for activities including but not limited to: formulary management, pharmacy utilization management, P&T administration, clinical review strategy, Part D operations, drug coverage policy, clinical program development, and more. Supervises clinical staff and works in collaboration with the whole pharmacy team to effectively administer pharmacy department services in accordance with applicable requirements.

The essential duties and responsibilities will include the following:

•Accomplish staff results by communicating job expectations; planning, monitoring, and appraising job results; coaching, counseling, and implementing corrective action steps when necessary; developing, coordinating, and enforcing systems, policies, procedures, and productivity standards. Complete performance evaluations in a timely manner.
•Oversee formulary management and proactively respond to availability of new drugs, changes to existing drugs, and other changes in the pharmaceutical landscape.
•Ensure proper formulary file maintenance and administration is conducted and issues are resolved.
•Supervise and work with clinical pharmacists to ensure clinical responsibilities are administered.
•Develop and implement clinical initiatives and programs to support appropriate use of pharmaceuticals by HPSM members when able.
•Oversee administration of services to fulfill all pharmacy Part D related operations not otherwise specified.
•Lead preparation for P&T Committee Meetings through the research, review, and documentation of materials in collaboration with the Director of Pharmacy.
•Lead development and maintenance of drug coverage policies, prior authorization protocols, and other pharmacy review guidelines for staff implementation.
•Lead and perform all functions of a clinical pharmacist as necessary to support operations.
•Conduct pharmacy utilization review and develop cost-effective pharmacy approaches to manage the pharmacy benefit in collaboration with the Director of Pharmacy
•Analyze and evaluate utilization trends to identify clinical and financial opportunities and make recommendations in accordance with results.
•Assist in resolution of disputed or questionable claims relative to medications.
•Make recommendations on program changes relative to coverage of pharmacy services.
•Advise others on the cost-effective delivery of pharmacy services.
•Professionally represent the Pharmacy Services Department and/or HPSM at internal and external meetings regarding pharmacy-related topics.
•Analyze new or updated regulations, laws and contract language and make appropriate updates to internal policies, procedures, and workflows as required.
•Manage and adapt all clinical pharmacy responsibilities to ensure compliance with any regulatory, quality or contractual changes as applicable.
•Perform other duties as assigned


Education and Experience: Licensure as a Pharmacist in the State of California. Pharm.D. degree from an ACPE accredited college of pharmacy program. Five (5) or more years’ experience in pharmacy. Three (3) or more years’ experience in a management position. Prior managed care experience is highly preferred.
Knowledge of: All aspects of pharmacy formulary management as they apply to HPSM including proper considerations for clinical (e.g., evidence-based medicine approach) and financial (e.g., incorporating utilization and rebate contract implications) factors. Pharmacy’s role in a managed care health plan setting in to manage the formulary, administer clinical initiatives/programs, and support appropriate pharmaceutical utilization by members. How current laws, regulations, and other requirements (e.g., APLs, HPMS memos) from DHCS, DMHC, and CMS affect pharmacy responsibilities within a health plan setting. Thoroughness, ensuring that one’s own and other’s work and information are complete and accurate. Customer focus; ability to connect with our members to build engagement and trust. Accountability: Takes responsibility for achieving results and meets the expectations that have been set forth. Interpersonal awareness: effectively listens to members and ability to notice and interpret others concerns and feelings and ability to communicate with respect. Professional demeanor; always acts in a professional manner with members. Cultural Sensitivity; ability to work effectively with all races, nationalities, cultures, disabilities, ages, and sexes. Personal computers and proficiency in Microsoft Office Suite applications, including Outlook, Word, Excel, Access and PowerPoint. Supervisory principles and practices as well as techniques and methods to organize and manage direct reports.

Ability to: Take initiative; plan work and carry out tasks without detailed instructions. Apply an understanding of pharmacy’s role in a health plan setting to drive appropriate use of pharmaceuticals and promote cost-effective utilization. Process and understand pharmacy utilization data at a health plan level. Excellent verbal and written communication skills. Communicate effectively internally and externally, both verbally and in writing. Interact effectively with physicians and employees at all levels of the organization

Compensation & Benefits:

Starting Compensation Range: – Depending on Experience

Benefits Information: Excellent benefits package offered, including HPSM paid premiums for employee’s Medical, Dental and Vision coverage. Employee pays a small portion of the dependent premiums (5%) for medical and dental benefits. Additional HPSM benefits include fully paid life, AD&D, and LTD insurance; retirement plan (HPSM contributes equivalent of 10% of annual compensation); holiday and vacation pay; tuition reimbursement plan; onsite fitness center and more.

How to Apply:

Application Process: To apply, submit a resume and cover letter with salary expectations to: Health Plan of San Mateo, Human Resources Department, 801 Gateway Blvd., Suite 100, South San Francisco, CA 94080 or via email: or via fax: (650) 616-8039. File by: Continuous until filled. The Health Plan of San Mateo is proud to be an Equal Opportunity Employer and encourages minority candidates of all backgrounds to apply.
Submissions without a Cover Letter and Salary Expectations may not be considered.

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