Regional Account Manager, Pharmacy Services (Remote)
About The Position
JOB DESCRIPTION Job Summary Leads and manages team of pharmacy staff responsible to ensure member access to medically necessary prescription drugs. Contributes to overarching pharmacy strategy for optimization of medication related health care outcomes, and quality cost-effective member care. Essential Job Duties Provides oversight of the Pharmacy Benefit Manager (PBM) for designated health plan(s), including tracking of service warranties and performance guarantees. Provides assistance with pharmacy related health plan and corporate projects. Supports state health plan functions, goals, and initiatives. Represents as direct pharmacy contact for state agencies as needed. Identifies pharmacy related trends and implements process improvement related changes as needed. Liaises with member and provider service teams for both Molina and the PBM. Maintains the pharmacy SharePoint and provides feedback and support related to website updates. Develops both routine and ad hoc pharmacy member and provider communications. Supports pharmacy leadership in reviewing and updating state specific policies and procedures to ensure compliance with contractual and regulatory requirements. Provides ad hoc pharmacy related reporting. Provides subject matter expertise for pharmacy compliance and legislative regulations. Provides support for corporate pharmacy quality related initiatives. Provides support for state/Office of Inspector General (OIG) investigations. Provides support for the state member lock-in program. Provides support for state specific formulary management. Provides support for health plan pharmacy encounters. Manages and resolves urgent issues for health plan(s). e.g. state complaints related to pharmacy. Supports and completes all pharmacy audits as required (SOX, CMS, internal, network, etc.). Acts as primary liaison to PBM for health plan(s). Provides supervision to pharmacy staff, and demonstrates accountability for performance. Provides coaching for pharmacy staff and helps identify and provide training needs in collaboration with pharmacy leadership.
Requirements
- At least 7 years of experience in pharmacy, pharmacy managed care or Pharmacy Benefit Manager(PBM), or equivalent combination of relevant education and experience or equivalent experience.
- At least 1 year management/leadership experience.
- Ability to present ideas and information concisely to varied audiences.
- Knowledge of processes and systems necessary to develop and deliver necessary training to departmental staff and internal customers.
- Ability to develop and maintain positive and effective work relationships with coworkers, clients, members, providers, regulatory agencies, and vendors.
- Proficiency in compiling data, creating reports and presenting information.
- Ability to meet established deadlines.
- Ability to function independently and manage multiple projects.
- Excellent verbal and written communication skills.
- Microsoft Office suite, and applicable software program(s) proficiency.
Nice To Haves
- Certified Pharmacy Technician (CPhT) and/or state pharmacy technician license (state specific if state required), or Doctor of Pharmacy (PharmD) license.
- If licensed, license must be active and unrestricted in state of practice.
- Health plan pharmacy operations experience.
Responsibilities
- Leads and manages team of pharmacy staff responsible to ensure member access to medically necessary prescription drugs.
- Contributes to overarching pharmacy strategy for optimization of medication related health care outcomes, and quality cost-effective member care.
- Provides oversight of the Pharmacy Benefit Manager (PBM) for designated health plan(s), including tracking of service warranties and performance guarantees.
- Provides assistance with pharmacy related health plan and corporate projects.
- Supports state health plan functions, goals, and initiatives.
- Represents as direct pharmacy contact for state agencies as needed.
- Identifies pharmacy related trends and implements process improvement related changes as needed.
- Liaises with member and provider service teams for both Molina and the PBM.
- Maintains the pharmacy SharePoint and provides feedback and support related to website updates.
- Develops both routine and ad hoc pharmacy member and provider communications.
- Supports pharmacy leadership in reviewing and updating state specific policies and procedures to ensure compliance with contractual and regulatory requirements.
- Provides ad hoc pharmacy related reporting.
- Provides subject matter expertise for pharmacy compliance and legislative regulations.
- Provides support for corporate pharmacy quality related initiatives.
- Provides support for state/Office of Inspector General (OIG) investigations.
- Provides support for the state member lock-in program.
- Provides support for state specific formulary management.
- Provides support for health plan pharmacy encounters.
- Manages and resolves urgent issues for health plan(s). e.g. state complaints related to pharmacy.
- Supports and completes all pharmacy audits as required (SOX, CMS, internal, network, etc.).
- Acts as primary liaison to PBM for health plan(s).
- Provides supervision to pharmacy staff, and demonstrates accountability for performance.
- Provides coaching for pharmacy staff and helps identify and provide training needs in collaboration with pharmacy leadership.
Benefits
- Molina Healthcare offers a competitive benefits and compensation package.
- Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
Number of Employees
5,001-10,000 employees
