Pharmacist, Utilization Management (UM) Remote

Molina Healthcare; City of Albany (NY); Remote; USD 80,000 - 189,000; Full time

Job summary

A healthcare organization based in New York is seeking a Pharmacy Services Manager. This role is responsible for pharmacy benefit management, ensuring compliance, and improving quality metrics. Candidates should have a Doctor of Pharmacy degree with 1-2 years of experience, and an active State Pharmacy License. The position offers a competitive compensation package ranging from $80,412 to $188,164 annually.

Benefits

Competitive benefits and compensation package

Qualifications

• 1 - 2 years post-graduate experience in pharmacy.
• Active and unrestricted State Pharmacy License is required.
• Continuing education to maintain an active license.

Responsibilities

• Act as a liaison between Molina and customers regarding pharmacy benefit.
• Ensure compliance with coverage determination and appeals process.
• Contribute to quality improvement projects.

Skills

Pharmacy expertise

Communication skills

Cost control initiatives

Education

Doctor of Pharmacy or equivalent

Job description

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.