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 Lead Pharmacist, Utilization Management (UM) will serve as a team lead to support the pharmacy manager in the daily operations of the pharmacy team as well as provide regular “on the ground” staffing for pharmacy operations. The Lead Pharmacist will have knowledge of and be capable of running all pharmacy prior authorization/UM operations; support team workflow and functions to maintain compliance with CMS guidelines; and work in accordance with department policies and procedures.

Key Lead duties include, but may not be limited to:

• Administrative – Assists manager with time-off requests and scheduling, staffing, and other HR or payroll related needs as needed.
• Strategic - Supports team goals as established and agreed upon by senior leadership.
• Quality – Supports clinical, cost, and value-based interventions/programs.

As a Molina UM Pharmacist, the Lead also:

• Reviews coverage determinations and appeals in a timely, compliant, and accurate manner.
• Acts as a liaison between Molina and its customers (members, providers, and pharmacies) with respect to the pharmacy benefit. 
• Serves as a formulary and drug information resource, assisting technicians and other departments with questions regarding drug coverage.
• 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 to develop annual training sessions for applicable staff regarding 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.

JOB QUALIFICATIONS

Required Education

• Doctor of Pharmacy or bachelor’s degree in Pharmacy with equivalent experience.
• Continuing education required to maintain an active pharmacist license.
• Required Experience
• Minimum 3 years post-graduate experience.
• Experience demonstrating strong communication/ interpersonal skills.

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.

Pay Range: $88,453 - $206,981 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

About Us

Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.