Pharmacist, Utilization Management/Prior Auth (Remote)

Job 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.

Essential Job Duties

• 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.

Required 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 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.

Preferred Qualifications