Clinical Quality Pharmacist (PBM)

Location: San Diego, California, United States; on-site at the San Diego Headquarters or another company location, with remote work possible only with management approval.

Salary: $108,515–$196,412 per year.

Company

hirify.global is a pharmacy benefit manager providing pharmaceutical and technology solutions that improve healthcare outcomes, cost, transparency, and decision-making.

What you will do

• Develop and implement clinical audits and quality reporting across client lines of business.
• Evaluate the accuracy of Prior Authorization, Appeals, and Utilization Management case reviews.
• Create and manage inter-rater reliability testing, analyze results, and report trends and improvement opportunities.
• Review Prior Authorization guidelines and notifications for compliance with accreditation, regulatory, and client requirements.
• Collaborate with internal departments, leadership, clients, and delegates to resolve non-compliance and improve processes through automation.
• Support targeted audits, delegation oversight, reviewer training, calibration sessions, corrective actions, and accreditation activities.

Requirements

• PharmD with 3+ years of experience, or an equivalent combination of education and experience, including at least 1 year of pharmacy practice.
• Experience in managed care, pharmacy benefit management, or a health plan setting, particularly in utilization management, clinical quality, or accreditation.
• Active, unencumbered registered pharmacist license in at least one U.S. state.
• Advanced working knowledge of Microsoft Office, Teams, and PDF document tools.
• Strong pharmacy services knowledge across retail, home infusion, and inpatient settings.
• Ability to analyze regulations and technical materials, prepare reports and procedures, solve practical problems, and communicate effectively with clients.

Nice to have

• Experience with NCQA and/or URAC accreditation standards.
• Experience with CMS Medicare Part D requirements.
• Managed care residency or other clinical experience.

Culture & Benefits

• Full-time exempt position with typical core hours from Monday through Friday, 8:00 a.m. to 5:00 p.m.; additional hours may be required.
• Medical, dental, vision, and wellness programs.
• Paid time off, company-paid holidays, incentive compensation, and a 401(k) with company match.
• Life and disability insurance, tuition reimbursement, and employee referral bonus.
• No regular travel, although attendance at local conferences and meetings may be required.