Pharmacist, Utilization Management (UM) Remote in MST/PST
About the position Molina Healthcare is hiring for a remote Pharmacist in our Utilization Management department. This role is 100% remote. The Pharmacist, UM will provide 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. You will also contribute to overarching pharmacy strategy for optimization of medication related health care outcomes, and quality cost-effective member care. Hours for this role will be 9:00AM - 5:30pm MST or 10:00AM - 6:30pm MST with rotating weekends and holidays.
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 assist 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.
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 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. Nice-to-haves
- Medicare Part D and/or Medicaid experience.
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