Health Plan Pharmacy Services Director

Molina Talent Acquisition; Des Moines (IA); À distance; USD 160 000 - 220 000; Plein temps

Avantages offerts par ce poste

Competitive benefits package

Résumé du poste

Molina Healthcare seeks an experienced Pharmacy Leader to oversee health plan pharmacy services, quality, cost-effectiveness, and compliance. This role partners with enterprise pharmacy leadership to align strategies and support NCQA accreditation programs.

The ideal candidate brings strong data analytics, regulatory acumen, and proven leadership to drive member care outcomes. Remote-friendly position, must reside in Eastern or Central Time zones; requires PharmD and 8+ years of pharmacy

Qualifications

• PharmD, active and unrestricted in applicable states.
• 8+ years as a pharmacist, including 5+ years in health care delivery.
• 3+ years of management/leadership experience.
• Ability to compile data, create reports, and present concisely.
• Strong organizational and time-management skills.

Responsabilités

• Serve as SME for assigned health plan(s) and lead operations.
• Represent health plan at state regulator meetings.
• Analyze pharmacy spend, trends, and rate advocacy data.
• Oversee centralized pharmacy utilization management.
• Collaborate with internal/external partners for issue resolution.
• Ensure NCQA and Molina policy compliance.
• Communicate with practitioners, pharmacists, and vendors.
• Advise leadership on programs, system needs, and regulatory changes.
• Support policy and procedure development for health plan pharmacy.
• Participate in NCQA accreditation, HEDIS, and disease management programs.

Connaissances

Data analysis

Report writing

Regulatory compliance

Leadership

Communication

Formation

Doctor of Pharmacy (PharmD)

Outils

SQL

Excel

Office Suite

Description du poste

***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