Pharmacist, Utilization Mgmt
3 months ago
JOB DESCRIPTION
Job Summary
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 (such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and pharmacy costs management), clinical pharmacy services (such as, therapeutic drug monitoring, drug regimen review, patient education, and medical staff interaction), and oversight (establishing and measuring performance metrics regarding patient outcomes, medications safety and medication use policies).
KNOWLEDGE/SKILLS/ABILITIES
The Pharmacist, UM will be responsible for reviewing coverage determinations and appeals in a timely, compliant, and accurate manner. The Pharmacist, UM will also be responsible for serving as a formulary and drug information resource, assisting technicians and other departments with questions regarding drug coverage.
- Acts as a liaison between Molina and its customers (members, providers and pharmacies) with respect to the pharmacy benefit.
- Serves as the formulary expert.
- Ensures Molina is compliant with the coverage determination and appeals process.
- Contributes to projects aimed at improving Star ratings, HEDIS, 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 Case Management department as part of a member-centered interdisciplinary care team.
- Works with the PBM to manage formulary changes and update marketing on any changes needed on the web or print versions of the formulary.
- Performs outreach to patients and physicians as part of quality and/or cost control initiatives.
- Provides leadership for the pharmacy call center team as delegated by the Manager.
- Identifies and implements programs to improve clinical outcomes stemming from medication selection, utilization, and adherence.
Required Education
- Doctor of Pharmacy or bachelor's degree in Pharmacy with equivalent experience.
- Continuing education required to maintain an active pharmacist license.
1 - 2 years post-graduate experience.
Required License, Certification, Association
Active and unrestricted State Pharmacy License for workplace and plan location.
Preferred Experience
- Medicare Part D or Medicaid experience.
- Managed care experience.
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
-
Pharmacist, Consultant
6 days ago
Long Beach, United States Blue Shield of CA Full timeYour Role The Pharmacist, Consultant (Quality Assurance Pharmacist) is responsible for the design, development, maintenance, and delivery of audit programs for the Prior Authorization/Drug Utilization program. Reporting to the Sr. Manager, Medication Policy, Pharmacy Services, this role facilitates new hire and ongoing audits and serves as a role-model and...
-
Pharmacist, Consultant
1 week ago
Long Beach, United States Blue Shield of California Full timeYour Role The Pharmacist, Consultant (Quality Assurance Pharmacist) is responsible for the design, development, maintenance, and delivery of audit programs for the Prior Authorization/Drug Utilization program. Reporting to the Sr. Manager, Medication Policy, Pharmacy Services, this role facilitates new hire and ongoing audits and serves as a role-model and...
-
Pharmacist, Consultant
5 days ago
Long Beach, United States Blue Shield of California Full timeYour Role The Pharmacist, Consultant (Quality Assurance Pharmacist) is responsible for the design, development, maintenance, and delivery of audit programs for the Prior Authorization/Drug Utilization program. Reporting to the Sr. Manager, Medication Policy, Pharmacy Services, this role facilitates new hire and ongoing audits and serves as a role-model and...
-
Pharmacist, Consultant
5 days ago
Long Beach, United States Blue Shield of California Full timeYour RoleThe Pharmacist, Consultant (Quality Assurance Pharmacist) is responsible for the design, development, maintenance, and delivery of audit programs for the Prior Authorization/Drug Utilization program. Reporting to the Sr. Manager, Medication Policy, Pharmacy Services, this role facilitates new hire and ongoing audits and serves as a role-model and...
-
Pharmacist, Consultant
2 weeks ago
Long Beach, United States Blue Shield Of California Full timeYour Role The Pharmacist, Consultant (Quality Assurance Pharmacist) is responsible for the design, development, maintenance, and delivery of audit programs for the Prior Authorization/Drug Utilization program. Reporting to the Sr. Manager, Medication Policy, Pharmacy Services, this role facilitates new hire and ongoing audits and serves as a role-model and...
-
Pharmacist, Consultant
2 weeks ago
Long Beach, United States Blue Shield of California Full timeYour Role The Pharmacist, Consultant (Quality Assurance Pharmacist) is responsible for the design, development, maintenance, and delivery of audit programs for the Prior Authorization/Drug Utilization program. Reporting to the Sr. Manager, Medication Policy, Pharmacy Services, this role facilitates new hire and ongoing audits and serves as a role-model and...
-
Pharmacist, Consultant
2 weeks ago
Long Beach, United States Blue Shield of California Full timeYour Role The Pharmacist, Consultant (Quality Assurance Pharmacist) is responsible for the design, development, maintenance, and delivery of audit programs for the Prior Authorization/Drug Utilization program. Reporting to the Sr. Manager, Medication Policy, Pharmacy Services, this role facilitates new hire and ongoing audits and serves as a role-model and...
-
Pharmacist, Consultant
6 days ago
Long Beach, United States Blue Shield of California Full timeYour Role The Pharmacist, Consultant (Quality Assurance Pharmacist) is responsible for the design, development, maintenance, and delivery of audit programs for the Prior Authorization/Drug Utilization program. Reporting to the Sr. Manager, Medication Policy, Pharmacy Services, this role facilitates new hire and ongoing audits and serves as a role-model and...
-
Pharmacist, Consultant
1 week ago
Long Beach, United States Blue Shield of California Full timeYour Role The Pharmacist, Consultant (Quality Assurance Pharmacist) is responsible for the design, development, maintenance, and delivery of audit programs for the Prior Authorization/Drug Utilization program. Reporting to the Sr. Manager, Medication Policy, Pharmacy Services, this role facilitates new hire and ongoing audits and serves as a role-model and...
-
Quality Assurance Pharmacist
3 days ago
Long Beach, California, United States Blue Shield Of California Full timeAbout the JobThe Quality Assurance Pharmacist will be responsible for ensuring compliance with regulatory and accreditation requirements through design, development, maintenance, and delivery of audit programs for Prior Authorization/Drug Utilization review. This role reports to the Sr. Manager, Medication Policy, Pharmacy Services.Main DutiesConduct and...
-
Quality Assurance Pharmacist Lead
3 days ago
Long Beach, California, United States Blue Shield of CA Full timeAbout the PositionBlue Shield of CA seeks a skilled Quality Assurance Pharmacist Lead to join our team. In this critical role, you will be responsible for designing, developing, maintaining, and delivering audit programs for the Prior Authorization/Drug Utilization program. This position reports to the Sr. Manager, Medication Policy, Pharmacy Services. A key...
-
Pharmacist, Consultant
5 days ago
Long Beach, CA, United States Blue Shield of California Full timeYour Role The Pharmacist, Consultant (Quality Assurance Pharmacist) is responsible for the design, development, maintenance, and delivery of audit programs for the Prior Authorization/Drug Utilization program. Reporting to the Sr. Manager, Medication Policy, Pharmacy Services, this role facilitates new hire and ongoing audits and serves as a role-model and...
-
Clinical Formulary Pharmacist
2 weeks ago
Long Beach, United States Disability Solutions Full timeAbout SCANSCAN Group is a not-for-profit organization dedicated to tackling the most pressing issues facing older adults in the United States. SCAN Group is the sole corporate member of SCAN Health Plan, one of the nation’s leading not-for-profit Medicare Advantage plans, serving more than 277,000 members in California, Arizona, Nevada, Texas and New...
-
Hospital Pharmacist Position
1 week ago
Myrtle Beach, South Carolina, United States Grand Strand Health Full time**Clinical Pharmacist Job Summary**We are seeking a highly skilled Clinical Pharmacist to join our team at Grand Strand Health. The successful candidate will be responsible for providing high-quality patient care and ensuring the safe and effective use of medications.**Responsibilities**As a Clinical Pharmacist, your primary responsibilities will...
-
Pharmacist
2 months ago
Myrtle Beach, United States Grand Strand Health Full timeDescription Grand Strand Medical Center is looking for afull-time day shift ClinicalPharmacist!At Grand Strand Medical Center, our pharmacists are an integral part of the patient’s care team. We work directly with our providers and nurses in a decentralized model and are extremely active in monitoring, adjusting, and recommending pharmacologic therapies....
-
Clinical Formulary Pharmacist
3 weeks ago
Long Beach, United States HealthCHEC Full timeAbout SCANSCAN Group is a not-for-profit organization dedicated to tackling the most pressing issues facing older adults in the United States. SCAN Group is the sole corporate member of SCAN Health Plan, one of the nation's leading not-for-profit Medicare Advantage plans, serving more than 277,000 members in California, Arizona, Nevada, Texas and New Mexico....
-
Ambulatory Care Pharmacist
6 days ago
Miami Beach, United States Mount Sinai Medical Center of Florida Full timeCompletes drug utilization reviews Leads and develops pharmacy clinical services Leader and mentor of the antimicrobial management and other clinical programs Participates in the design, collection, and reporting of adverse drug reactions, drug utili Ambulatory Care, Pharmacist, Ambulatory, Operations, Clinical, Pharmacy, Healthcare
-
Pharmacist
3 weeks ago
Myrtle Beach, United States Grand Strand Health Full timeDescription Grand Strand Medical Center is looking for a full-time day shift Clinical Pharmacist! At Grand Strand Medical Center, our pharmacists are an integral part of the patients care team. We work directly with our providers and nurses in a decentralized model and are extremely active in monitoring, adjusting, and recommending pharmacologic therapies....
-
Clinical Formulary Pharmacist
4 days ago
Long Beach, United States Scangroup Full timeDescription About SCAN SCAN Group is a not-for-profit organization dedicated to tackling the most pressing issues facing older adults in the United States. SCAN Group is the sole corporate member of SCAN Health Plan, one of the nation's leading not-for-profit Medicare Advantage plans, serving more than 277,000 members in California, Arizona, Nevada, Texas...
-
Clinical Formulary Pharmacist
4 hours ago
Long Beach, United States HealthCHEC Full timeAbout SCAN SCAN Group is a not-for-profit organization dedicated to tackling the most pressing issues facing older adults in the United States. SCAN Group is the sole corporate member of SCAN Health Plan, one of the nation’s leading not-for-profit Medicare Advantage plans, serving more than 277,000 members in California, Arizona, Nevada, Texas and New...
