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 with regard to patient outcomes, medications safety and medication use policies).
Molina Clinical Pharmacists provide a clinical pharmacy outreach service to educate patients and their health care team in order to optimize medication related healthcare outcomes, ensure patient safety, recommend cost-effective medication strategies, and coordinate care efficiently and effectively. These pharmacists may also be involved in providing utilization management/prior authorization services.
Key duties include any or all of the following:
• Provides medication therapy management including examination of member medical records, performing a comprehensive medication review and communicating with members and providers, including outbound calls to members to discuss their medications.
• Reviews members' medication profiles and applies evidence based medicine and national guidelines when creating recommendations to health care providers for optimizing the members' medication regimen.
• Analyzes and reviews medication lists for potential patient safety problems, including drug interactions, suboptimal medication regimens, etc.
• Promotes clinically appropriate prescribing practices based on evidence based medicine and national guidelines through various modalities (provider/plan profiling, member drug profile reviews, medication protocols/criteria, and case-by-case intervention).
• Performs prior authorization reviews of high-cost medications and deferred authorization requests as needed.
• Researches, develops and implements drug utilization and disease state management strategies and intervention techniques to deliver high quality, cost effective healthcare.
• Assists in coordination of care for pharmacy-related issues between members, providers and other members of the member's interdisciplinary care team, including referrals to state plan health care services.
• Follows up with members and providers to check on progress toward meeting drug treatment goals.
• Serves as a drug information resource to Pharmacy staff, Medical Affairs staff and Providers.
• Reviews and analyzes pharmacy benefit manager reports to track general trends in drug utilization and identify potential targeted utilization management activities.
• Works with Health Care Services (e.g., with data manager, case managers, etc.) on member-centered interdisciplinary teams.
• May prepare drug monographs and utilization reports for the Pharmacy & Therapeutics Committee.
• Assists Director with developing/updating policies and procedures andimplementing changes to comply with state and federal regulations.
• Doctor of Pharmacy (Bachelor's Degree in Pharmacy plus 10 years of relevant experience, including clinical work, will be considered in lieu of Pharm.D.)
• Continuing education required to maintain an active pharmacist license.
• ASHP-accredited residency or 2-3 years relevant Pharmacy experience.
• Current knowledge and expertise in clinical pharmacology and disease management.
Required License, Certification, Association
Active State Pharmacy License with no restrictions.
• Experience with Medicaid and / or Medicare programs.
• Clinical skills or pharmacotherapy expertise for MTMP-related conditions and medications.
• Experience with team-based care.