Pharmacist, Utilization Management Specialist
2 weeks ago
Molina Healthcare is seeking a highly skilled Pharmacist, Utilization Management to join our team. As a key member of our pharmacy team, you will play a critical role in ensuring that our members have access to necessary prescription medications in a cost-effective and safe manner.
Key Responsibilities- Review coverage determinations and appeals in a timely, compliant, and accurate manner.
- Serve as a formulary and drug information resource, assisting technicians and other departments with questions regarding drug coverage.
- Act as a liaison between Molina and its customers (members, providers, and pharmacies) with respect to the pharmacy benefit.
- Contribute to projects aimed at improving Star ratings, HEDIS, CAHPS, and other quality metrics.
- Assist call center pharmacy technicians with clinical questions and phone calls from prescribers, pharmacies, and/or members.
- Develop, implement, and maintain pharmacy cost control and quality initiatives under the direction of leadership.
- Monitor drug utilization and assist leadership in understanding quality and cost control issues related to pharmacy.
- Work in tandem with Molina Medical Directors to ensure accurate coverage determination decisions.
- Work with leadership on developing annual training sessions for applicable staff regarding pharmacy benefit changes for the upcoming year.
- Work with the Case Management department as part of a member-centered interdisciplinary care team.
- Work with the PBM to manage formulary changes and update marketing on any changes needed on the web or print versions of the formulary.
- Perform outreach to patients and physicians as part of quality and/or cost control initiatives.
- Provide leadership for the pharmacy call center team as delegated by the Manager.
- Identify and implement programs to improve clinical outcomes stemming from medication selection, utilization, and adherence.
- 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.
- Active and unrestricted State Pharmacy License for workplace and plan location.
Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. We offer a competitive benefits and compensation package to our employees.
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