Health Plan Pharmacy Services Director

Molina Healthcare; Des Moines (IA); On-site; USD 102,000 - 209,000; Full time

Job summary

Molina Healthcare is seeking a pharmacist leader to direct health plan pharmacy programs, driving quality, cost-effectiveness, and compliance initiatives. You will collaborate with shared services and regulators to align strategy and optimize medication-related outcomes.

Ideal candidates have extensive pharmacist experience, strong data analysis, and a proven ability to lead teams, manage stakeholders, and implement NCQA/HEDIS initiatives within a national payer environment.

Qualifications

• Pharmacist with an active PharmD license.
• 8+ years of pharmacist experience including 5 years in healthcare delivery.
• 3+ years of management/leadership experience.
• Ability to compile data, create reports, and present to varied audiences.

Responsibilities

• Lead as SME for assigned health plan(s) and represent at regulator meetings.
• Analyze trends and pharmacy spend for rate advocacy with the state.
• Collect and report pharmacy data and maintain confidential information.
• Oversee centralized pharmacy utilization management team.

Skills

Pharmacist professional experience

Communication skills

Data analysis

Education

Doctor of Pharmacy (PharmD)

Tools

Microsoft Office

SQL

Excel

Job description

Remote and must live in the Eastern or Central Time Zone

JOB DESCRIPTION

Job Summary

Provides deep subject matter expertise and leadership for health plan pharmacy services. Serves as the designated leader for assigned health plan pharmacy program(s) supporting quality, cost-effectiveness, and compliance initiatives. Collaborates with shared services pharmacy leadership to ensure that assigned health plan pharmacy program is consistent with enterprise pharmacy strategy. Contributes to overarching pharmacy strategy for optimization of medication related health care outcomes, and quality cost-effective member care.

Essential Job Duties

• Represents as the assigned pharmacy leader/subject matter expert (SME) for assigned health plan(s).
• Represents health plan at meetings with state regulators as the designated pharmacy representative.
• Performs and compiles analysis on emerging trends, forecasts, and pharmacy spend and uses data in rate advocacy work with the state.
• Collects and compiles pharmacy data for reporting purposes and maintains files of confidential information submitted for review.
• Provides oversight and direction to centralized pharmacy utilization management team.
• Partners with internal and external customers to ensure prompt resolution of identified issues and serve as the first point of contact for internal departments.
• Ensures that pharmacy activities and processes are compliant with National Committee for Quality Assurance (NCQA) guidelines and Molina policies and procedures, and promotes best practice measures to ensure consistency.
• Communicates with practitioners, pharmacists, and drug representatives.
• Advises pharmacy leadership on operational issues, program and system needs, and regulatory changes.
• Supports development of health plan pharmacy-related policies and procedures.
• Participates in quality management and health education programs including, but not limited to NCQA accreditation, Healthcare Effectiveness Data Information Set (HEDIS), and disease management programs.

Required Qualifications

• At least 8 years of experience as a pharmacist, including 5 years of health care delivery experience, or equivalent combination of relevant education and experience.
• At least 3 years of management/leadership experience.
• Active and unrestricted Doctor of Pharmacy (PharmD) in applicable state(s).
• Ability to compile data, create reports, and present information and ideas concisely to varied audiences.
• Strong organizational and time-management skills.
• Ability to develop and maintain positive and effective work relationships with coworkers, members, providers, regulatory agencies, and vendors.
• Excellent verbal and written communication skills.
• Microsoft Office suite and applicable software program(s) proficiency.

Preferred Qualifications

• Managed care or Pharmacy Benefit Management (PBM) experience.
• Knowledge/experience with decision analysis and data analysis tools, such as SQL and Microsoft Excel

Molina Healthcare offers a competitive benefits and compensation package.

Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Pay Range: $101,677 - $208,705.4 / ANNUAL

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