Pharmacist, Utilization Management (UM) (Remote)

Molina Healthcare; Long Beach (CA); Remote; USD 100,000 - 130,000; Full time

Job summary

Molina Healthcare seeks a Pharmacist, UM to oversee pharmacy benefit programs ensuring compliance with federal and state regulations. This role involves reviewing drug coverage, contributing to quality initiatives, and collaborating with clinical teams to enhance medication use and safety.

Benefits

Competitive benefits package

Equal Opportunity Employer (EOE)

Qualifications

• Active State Pharmacy License required.
• 1 - 2 years of post-graduate experience preferred.

Responsibilities

• Review coverage determinations and appeals promptly.
• Serve as a liaison with members and providers.
• Develop and implement pharmacy cost control initiatives.

Skills

Communication

Clinical Decision-Making

Formulary Management

Quality Improvement

Education

Doctor of Pharmacy

Bachelor's degree in Pharmacy

Job description

JOB DESCRIPTION

Job Summary

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).

KNOWLEDGE/SKILLS/ABILITIES

The Pharmacist, UM will be responsible for reviewing coverage determinations and appeals in a timely, compliant, and accurate manner. The Pharmacist, UM will also be responsible for serving as a formulary and drug information resource, assisting technicians and other departments with questions regarding drug coverage.

• 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.