120 Best pharmacy delivery Jobs in San Francisco, California (September 2025)

San Francisco Health Plan

Clinical Pharmacist

11 days ago

San Francisco

Job Description Reporting to the Director, Pharmacy, the Clinical Pharmacist is an integral member of the SFHP Pharmacy Team. You will provide support and expertise to the Care Management team, Population Health team, Grievances & Appeals, and the Quality Improvement (QI) Program. These groups provide both direct medication-related counseling to select/targeted members and medication-related consultative expertise to other Health Services clinical staff. They produce Drug Utilization Review (DUR) analyses as required and respond to pharmacy-related population health priorities. You will support the QI program via measure development, tracking, and data analysis, end-to-end formulary management for Medicare Part D/DSNP and commercial lines of business, and provide oversight of Medi-Cal pharmacy utilization, including state-level advocacy and provider support. You will work closely with the Pharmacy Benefit Manager (PBM), healthcare providers, beneficiaries, and internal team members to ensure that SFHP's Medicare Part D/DSNP and commercial plans are effectively managed, cost effective, and compliant with regulatory requirements. Please note that while SFHP supports a hybrid work environment, the Clinical Pharmacist is not required to meet the minimum in-office requirement of 4x/month, but is required to attend company meetings and other in-person events at Director's discretion. Salary: $140,000 - $160,000 per year WHAT YOU WILL DO: • Medication Therapy Management:, • Be available to Health Services staff for ad hoc information queries related to the medications being taken by members for whom staff is providing either direct care coordination or utilization review., • On an ad hoc basis, help coordinate medication-related discharge planning by assessing planned discharge medication for coverage barriers (either through SFHP or Medi-Cal Rx) and coordinating coverage steps so as not to delay discharge or render a member unable to access necessary medication post-discharge., • On select members, participate in the discharge planning/post-discharge repatriation process. This may involve member education about new medications taken post-hospital discharge or conducting a formal medication reconciliation assessment and communicating findings/recommendations., • Provide medication therapy management (MTM) assessment and recommendations to select members engaged in either SFHP's disease management programs (asthma, diabetes), CareSupport program, or complex medical case management program, including CalAIM populations of focus., • Provide MTM services to members identified through administrative identification queries based upon the type, number, and complexity of chronic medications taken., • Participate in multidisciplinary Care Management meetings and offer suggestions to address members' medication needs., • Provides oversight of delegated MTM services to improve the quality of care for Medicare beneficiaries. This includes reviewing medications for drug interactions, side effects, duplication of therapy, and opportunities for improving adherence. The pharmacist may also reach out to beneficiaries to conduct these reviews., • Drug Utilization Review:, • Complete DUR analyses, including methodology and design, data collection and stewardship, and analysis and recommendation development, and present to SFHP DUR Board (Pharmacy & Therapeutics Committee), internal partners (e.g., DUR workgroup), and/or external partners (e.g., medical groups) as indicated to support collaborative population health management efforts., • Plan and implement tailored educational initiatives to members, prescribers and pharmacies in the community based on DUR analyses., • Oversee all DUR initiatives to ensure they are thoroughly researched, carefully designed to provide maximum value, benchmarked when possible and documented for executive and committee review., • Analyze prescription drug claims data to identify patters of drug use, potential therapeutic issues, and opportunities for improving care. This may include identifying high-risk patients, high-cost drug categories, and trends in medication usage., • Evaluate the outcomes of interventions, such as formulary changes or adherence programs, to assess their effectiveness in improving clinical outcomes and reducing overall costs., • Complete the Annual DUR Report questionnaire and all required attachments by March each year and represent SFHP at DHCS DUR meetings., • Quality and Population Health:, • Collaborate with Health Services staff to address population health priorities and align efforts through QI, DUR and other programs., • Communicate with and oversee vendors related to quality and population management (e.g., Care Management tool, First Databank functionality)., • Review data trends for quality improvement and opportunities for measure development and tracking., • Support medication-related HEDIS and NCQA efforts, including data collection, integrity, and analysis and working cross-functionally with Health Services and Business Analytics staff., • Formulary Management:, • Conduct weekly drug reviews and coordinate with PBM to implement recommended updates into the claims processor., • Conduct annual review of all custom prior authorizations (PA) following current clinical standards of care and coordinate with PBM to implement recommended updates into the decision algorithm and staff training., • Provide clinical support to Pharmacy Analysts in oversight of PBM PA team to ensure clinically supported decision making and documentation, in alignment with all regulatory requirements., • Document all interim changes to formulary and PA criteria for retroactive Pharmacy & Therapeutics (P&T) Committee approval., • Develop class reviews and monographs on a quarterly basis to support custom formulary and P&T process for commercial lines of business., • Create, and review utilization management (UM) criteria for Physician Administered Drugs (PADs) and Part B drugs, where applicable., • Review PADs and Part B drug requests, in collaboration with the UM team., • Provide support for Grievances & Appeals process including clinical review of appeals when needed, documentation through the case management tool, and case presentation and follow-up via the UM Committee, and PBM PA team oversight and communication/retrain, and identification of operationalization of PA criteria and process improvement opportunities, • Compliance and Regulatory:, • Ensure our plans comply with the regulations and guidelines set by regulatory bodies. This includes ensuring that the formulary and drug utilization practices meet all regulatory requirements., • Help with internal and external audits related to compliance. Provide documentation, data analysis, and explanations of clinical decisions to ensure we meet regulatory standards., • Prepare reports for regulatory bodies and internal stakeholders about drug coverage, medication utilization, and any clinical interventions made to improve patient care., • Data Analysis and Outcomes:, • Analyze prescription drug claims data to identify patterns of drug use, potential therapeutic issues, and opportunities for improving care. This may include identifying high-risk patients, high-cost drug categories, and trends in medication usage., • Evaluate the outcomes of interventions, such as formulary changes or adherence programs, to assess their effectiveness in improving clinical outcomes and reducing overall costs., • Collaborate with Health Services staff to address population health priorities and align efforts through QI, DUR and other programs., • Bring issues to the attention of the Pharmacy Director with recommendations for solution., • Registered Pharmacist (Doctor of Pharmacy, preferred) with a valid and unrestricted California State license., • 1+ years of experience with one or more of the following, preferred:, • Medication Therapy Management program development and/or delivery, • Drug Utilization Review analysis, development, and/or delivery, • Quality Improvement program development and/or delivery, • Formulary management development and/or delivery, • Experience in an HMO or experience in managed care setting, preferred., • Knowledge of and experience with state and federal insurance programs, preferred. WHAT WE OFFER: • Health Benefits, • Medical: You'll have a choice of medical plans, including options from Kaiser and Blue Shield of California, heavily subsidized by SFHP., • Dental: You'll have a choice of a basic dental plan or an enhanced dental plan which includes orthodontic coverage., • Vision: Employee vision care coverage is available through Vision Service Plan (VSP)., • Retirement – Employer-matched CalPERS Pension and 401(a) plans, 457 Plan., • Time off – 23 days of Paid Time Off (PTO) and 13 paid holidays. Established in 1997, San Francisco Health Plan (SFHP) is an award-winning, managed care health plan whose mission is to provide affordable health care coverage to the underserved low and moderate-income residents in San Francisco County. SFHP is chosen by eight out of every ten San Francisco Medi-Cal managed care enrollees and its 175,000+ members have access to a full spectrum of medical services including preventive care, specialty care, hospitalization, prescription drugs, and family planning services. San Francisco Health Plan is proud to be an equal opportunity employer. We are committed to a work environment that supports, inspires, and respects all individuals and in which our people processes are applied without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, marital status, age, disability, national or ethnic origin, military service status, citizenship, or other protected characteristics. Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. San Francisco Health Plan is an E-Verify participating employer. Hiring priority will be given to candidates residing in the San Francisco Bay Area and California. #LI-Hybrid (Hybrid remote/in-office)

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