Pharmacist, Utilization Management (Remote)

Molina Healthcare•Long Beach, CA

1d•Remote

About The Position

Molina Healthcare is hiring for a remote Pharmacist, UM/Prior Auth. This role provides support and subject matter expertise for pharmacy formulary liaison activities between the business and its customers (members, providers and pharmacies) to determine coverage and informative drug use. The Pharmacist contributes to the overarching pharmacy strategy for optimization of medication related health care outcomes, and quality cost-effective member care. The position acts as a liaison between Molina and its customers with respect to the pharmacy benefit and serves as the designated formulary expert. It ensures compliance with coverage determination and appeals processes and contributes to projects aimed at improving STAR ratings, HEDIS, CAHPS, and other quality metrics. The role also involves assisting call center pharmacy technicians with clinical questions, developing and maintaining pharmacy cost-control and quality initiatives, monitoring drug utilization, and working with medical directors and the care management department. The Pharmacist will also collaborate with the Pharmacy Benefit Manager (PBM) on formulary changes and perform outreach to members and physicians for quality and cost-control initiatives. The hours will be Monday through Friday 10am- 630 central time with rotating weekends.

Requirements

At least 3 years of experience in a pharmacy, Pharmacy Benefit Manager(PBM), formulary, and/or managed care setting, and 1-2 years post-graduate experience, or equivalent combination of relevant education and experience.
Active and unrestricted Doctor of Pharmacy (PharmD) in applicable state(s).
Current knowledge and expertise in clinical pharmacology and disease management.
Ability to present ideas and information concisely to varied audiences.
Knowledge of processes and systems necessary to develop and deliver training to departmental staff and internal customers.
Ability to develops and maintains positive and effective work relationships with coworkers, members, providers, regulatory agencies and vendors.
Proficiency compiling data, creating reports and presenting information.
Ability to meet established deadlines.
Functions independently and manages multiple projects.
Excellent verbal and written communication skills.
Microsoft Office suite (including Excel), and applicable software program(s) proficiency.

Nice To Haves

Medicare Part D and/or Medicaid experience.
Managed care experience.

Responsibilities

Acts as a liaison between Molina and its customers (members, providers and pharmacies) with respect to the pharmacy benefit.
Serves as the designated formulary expert.
Ensures Molina is compliant with the coverage determination and appeals process.
Contributes to projects aimed at improving STAR ratings, Healthcare Effectiveness Data Information Set (HEDIS), Consumer Assessment of Healthcare Providers and Services (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 care management department as part of a member-centered interdisciplinary care team (ICT).
Works with the Pharmacy Benefit Manager (PBM) to manage formulary changes and update marketing on any changes needed on the web or print versions of the formulary.
Performs outreach to members and physicians as part of quality and/or cost-control initiatives.
Provides leadership for the pharmacy call center team under the direction of pharmacy senior leadership.
Identifies and implements programs to improve clinical outcomes stemming from medication selection, utilization, and adherence.