This position operates on a hybrid work schedule. This position will require 3 days onsite at the Monrovia or Huntington Beach office.
Are you ready to make a lasting impact and transform the healthcare space? We are one of Southern California's fastest-growing Medicare Advantage plans with an incredible 112% year-over-year membership growth.
Who Are We?
Clever Care was created to meet the unique needs of the diverse communities we serve. Our innovative benefit plans combine Western medicine with holistic Eastern practices, offering benefits that align with our members' culture and values.
Why Join Us?
We're on a mission! Our rapid growth reflects our commitment to making healthcare accessible for underserved communities. At Clever Care, you'll have the opportunity to make a real difference, shape the future of healthcare, and be part of a fast-moving, game-changing organization that celebrates diversity and innovation.
Job Summary
The Clinical Pharmacist helps build and run a reliable, member-centered pharmacy function for a Medicare Advantage Prescription Drug plan. This role combines clinical pharmacy judgment, Medicare Part D operational knowledge, formulary support, quality improvement, and close collaboration with internal teams and PBM partners.
As part of Clever Care's mission, this pharmacist will help advance culturally attuned pharmacy care by ensuring medication support, workflows, and member interactions reflect language, culture, trust, and real-life member experience. We are looking for someone who can move comfortably between clinical review, compliance requirements, daily operations, and process improvement, and who is energized by using technology in practical ways to make pharmacy workflows easier for members, providers, and staff.
Core Responsibilities
- Medicare pharmacy case review: Review Part D coverage determinations, formulary exceptions, redeterminations, and related cases using clinical judgment, benefit rules, CMS guidance, and clear documentation.
- Medication therapy and MTM support: Review medications for safety, dosing, effectiveness, adherence opportunity, formulary alignment, and member-specific needs; support MTM, care management, and interdisciplinary care discussions as needed.
- Formulary, UM, and AEP readiness: Help keep formulary, prior authorization, and exception criteria clinically sound, operationally usable, CMS-aligned, and ready for annual enrollment period changes.
- Part B drug and CDAG support: Support Part B drug-related reviews and Coverage Determinations, Appeals, and Grievances workflows, including case review, documentation, escalation, and follow-up with compliance and operations.
- PBM oversight and issue resolution: Help monitor PBM-delegated work, track vendor performance, resolve pharmacy claims rejects and access issues, and make sure escalations do not get lost between teams.
- Compliance and audit readiness: Support CMS audit universes, source documentation, monitoring, corrective actions, and day-to-day compliance follow-through so we are ready before an audit, not scrambling during one.
- Medication adherence and Stars: Support adherence, high-risk medication, and other pharmacy-related quality initiatives through outreach workflows, performance tracking, trend review, and practical process fixes.
- Technician oversight: Provide day-to-day coaching, training, quality review, and practical direction for pharmacy technicians supporting clinical pharmacy operations and member-facing workflows.
- Reporting, trends, and workflow improvement: Use case data, dashboards, reports, and team feedback to identify problems early, improve handoffs, simplify workflows, and give leadership useful visibility.
- Culturally attuned member experience: Help our CMIO and Clinical Team build pharmacy processes that work in real life for our members, including language needs, cultural preferences, trust barriers, and how members actually use medications.