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Medicare Advantage Staff Pharmacist

University of California - Los Angeles Health
United States, California, Los Angeles
Aug 13, 2025
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