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Pharmacist, Utilization Management (UM) Remote

Molina Healthcare

Louisville (KY)
À distance
USD 80 000 - 189 000
Aujourd’hui
Soyez parmi les premiers à postuler
Je veux recevoir les dernières offres d’emploi à Whitby

Remote Marketing Lead - Arbitrum

Blockchain Works

Louisville (KY)
À distance
USD 70 000 - 120 000
Aujourd’hui
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Logistics Sales Manager

https:/jobs.gogpac.com/gpac/search/Apply/all/1003/504424900/Logistics%20Sales%20Manager.html

Broken Bow (NE)
À distance
USD 70 000 - 100 000
Aujourd’hui
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Learning & Growth Specialist | Remote | Redefine Your Career

Jobsoid Inc.

Portland (OR)
À distance
USD 80 000 - 100 000
Aujourd’hui
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Manager, Provider Configuration Maintenance - QNXT/Claims - Remote in GA

Molina Healthcare

Louisville (KY)
À distance
USD 80 000 - 189 000
Aujourd’hui
Soyez parmi les premiers à postuler
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Talent Acquisition Remote

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À distance
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Entry Level Remote Recruiter Opportunity

https:/jobs.gogpac.com/gpac/search/Apply/all/2769/504402334/Entry%20Level%20Remote%20Recruiter%20Opp

Concordia (KS)
À distance
USD 10 000 - 60 000
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The Cigna Group

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Portland (OR)
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Specialist, Medicare Member Engagement-Bilingual-(Remote)-PST hours

Molina Healthcare

Louisville (KY)
À distance
USD 60 000 - 80 000
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Insurance Defense Litigator - Partner Level

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Pharmacist, Utilization Management (UM) Remote
Molina Healthcare
Louisville (KY)
À distance
USD 80 000 - 189 000
Plein temps
Aujourd’hui
Soyez parmi les premiers à postuler

Résumé du poste

A leading healthcare organization in Louisville is seeking a Pharmacy Services Manager to oversee the pharmacy benefit programs and ensure compliance with federal and state laws. The ideal candidate will have a Doctor of Pharmacy degree and at least 1-2 years of post-graduate experience. Responsibilities include liaising with customers, ensuring compliance, and monitoring drug utilization to improve clinical outcomes. A competitive salary ranging from $80,412 to $188,164 annually is offered.

Prestations

Competitive benefits and compensation package

Qualifications

  • 1 - 2 years post-graduate experience.
  • Continuing education required to maintain an active pharmacist license.
  • Active and unrestricted State Pharmacy License for workplace and plan location.

Responsabilités

  • Act as a liaison between Molina and its customers regarding pharmacy benefits.
  • Serve as the formulary expert.
  • Ensure compliance with coverage determination and appeals process.
  • Contribute to projects aimed at improving quality metrics.
  • Assist pharmacy technicians with clinical questions.

Connaissances

Pharmacy benefit management
Clinical pharmacy services
Formulary management
Cost control initiatives
Patient outreach

Formation

Doctor of Pharmacy or bachelor's degree in Pharmacy
Description du poste
Overview

Molina Pharmacy Services/Management staff work to ensure that Molina members have access to all medically necessary prescription drugs and those drugs are used in a cost-effective, safe manner. These jobs are responsible for creating, operating, and monitoring Molina Health Plan's pharmacy benefit programs in accordance with all federal and state laws. Jobs in this family include those involved in formulary management (such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and pharmacy costs management), clinical pharmacy services (such as, therapeutic drug monitoring, drug regimen review, patient education, and medical staff interaction), and oversight (establishing and measuring performance metrics regarding patient outcomes, medications safety and medication use policies).

Responsibilities
  • Acts as a liaison between Molina and its customers (members, providers and pharmacies) with respect to the pharmacy benefit.
  • Serves as the formulary expert.
  • Ensures Molina is compliant with the coverage determination and appeals process.
  • Contributes to projects aimed at improving Star ratings, HEDIS, CAHPS, and other quality metrics.
  • Assists call center pharmacy technicians with clinical questions and phone calls from prescribers, pharmacies and/or members.
  • Develops, implements and maintains pharmacy cost control and quality initiatives under the direction of leadership.
  • Monitors drug utilization and assists leadership team in understanding quality and cost control issues related to pharmacy.
  • Works in tandem with Molina Medical Directors to ensure accurate coverage determination decisions.
  • Works with leadership on developing annual training sessions for applicable staff regarding the pharmacy benefit changes for the upcoming year.
  • Works with the Case Management department as part of a member-centered interdisciplinary care team.
  • Works with the PBM to manage formulary changes and update marketing on any changes needed on the web or print versions of the formulary.
  • Performs outreach to patients and physicians as part of quality and/or cost control initiatives.
  • Provides leadership for the pharmacy call center team as delegated by the Manager.
  • Identifies and implements programs to improve clinical outcomes stemming from medication selection, utilization, and adherence.
Job Qualifications
Required Education
  • Doctor of Pharmacy or bachelor’s degree in Pharmacy with equivalent experience.
  • Continuing education required to maintain an active pharmacist license.
Required Experience

1 - 2 years post-graduate experience.

Required License, Certification, Association

Active and unrestricted State Pharmacy License for workplace and plan location.

Preferred Experience
  • Medicare Part D or Medicaid experience.
  • Managed care experience.

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $80,412 - $188,164 / ANNUAL

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

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* Le salaire de référence se base sur les salaires cibles des leaders du marché dans leurs secteurs correspondants. Il vise à servir de guide pour aider les membres Premium à évaluer les postes vacants et contribuer aux négociations salariales. Le salaire de référence n’est pas fourni directement par l’entreprise et peut pourrait être beaucoup plus élevé ou plus bas.

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