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

Role Description

Molina Healthcare is hiring a Pharmacist in our Utilization Management/Prior Auth department. This position will be working Monday through Friday from 10:00am to 6:30pm CST with rotating weekends and holidays. Candidates can be licensed in any state but will need to be licensed in AZ and NM within 90 days of employment.

• 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.
• Contributes to overarching pharmacy strategy for optimization of medication-related health care outcomes and quality cost-effective member care.
• 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.

Qualifications

• 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 develop and maintain 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.

Preferred Qualifications

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

Benefits

Molina Healthcare offers a competitive benefits and compensation package.

Company Description

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