[Hiring] Pharmacist, Prior Authorization/Utilization Management @Molina Healthcare

Role Description

Molina Healthcare is hiring for a Pharmacist in our UM/Prior Authorization department. Candidates must be licensed to practice in the state of Florida or be able to obtain Florida licensure within 90 days of starting. This position is remote and can be worked from a variety of locations within the US.

Shift times can be either 8 or 10 hour shifts between the times of 7a and 10p EST with rotating weekends depending on business needs.

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 (reviewing prior authorization requirements, reviewing drug/provider utilization patterns, and pharmacy costs management)
• Clinical pharmacy services (therapeutic drug monitoring, drug regimen review, patient education, and medical staff interaction)
• Oversight (establishing and measuring performance metrics regarding patient outcomes, medication safety, and medication use policies)

The Pharmacist, UM will be responsible for:

• Reviewing coverage determinations and appeals in a timely, compliant, and accurate manner.
• Serving as a formulary and drug information resource, assisting technicians and other departments with questions regarding drug coverage.
• Acting as a liaison between Molina and its customers (members, providers, and pharmacies) with respect to the pharmacy benefit.
• Ensuring Molina is compliant with the coverage determination and appeals process.
• Contributing to projects aimed at improving Star ratings, HEDIS, CAHPS, and other quality metrics.
• Assisting call center pharmacy technicians with clinical questions and phone calls from prescribers, pharmacies, and/or members.
• Developing, implementing, and maintaining pharmacy cost control and quality initiatives under the direction of leadership.
• Monitoring drug utilization and assisting the leadership team in understanding quality and cost control issues related to pharmacy.
• Working in tandem with Molina Medical Directors to ensure accurate coverage determination decisions.
• Working with leadership on developing annual training sessions for applicable staff regarding the pharmacy benefit changes for the upcoming year.
• Working with the Case Management department as part of a member-centered interdisciplinary care team.
• Working with the PBM to manage formulary changes and update marketing on any changes needed on the web or print versions of the formulary.
• Performing outreach to patients and physicians as part of quality and/or cost control initiatives.
• Providing leadership for the pharmacy call center team as delegated by the Manager.
• Identifying and implementing programs to improve clinical outcomes stemming from medication selection, utilization, and adherence.

Qualifications

• Doctor of Pharmacy or bachelor’s degree in pharmacy with equivalent experience.
• Continuing education required to maintain an active pharmacist license.

Requirements

• 1 - 2 years post-graduate experience.
• Active and unrestricted State Pharmacy License for workplace and plan location.

Preferred Experience

• Medicare Part D or Medicaid experience.
• Managed care experience.

Benefits

Molina Healthcare offers a competitive benefits and compensation package.

Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.