Molina Healthcare

Health Plan Pharmacy Services Director

Molina Healthcare$120K — $145K *
Healthcare
8 - 10 years of experience
Job Overview by Ladders

Qualifications

  • 8+ years as a pharmacist, with 5+ years in healthcare delivery or equivalent education/experience.
  • 3+ years in management or leadership roles.
  • Active PharmD license in the applicable state(s).
  • Proficient in compiling and presenting data and reports.
  • Strong organizational and time-management skills.
  • Effective relationship-building with colleagues, members, and regulatory agencies.
  • Excellent written and verbal communication skills.

Responsibilities

  • Serve as the pharmacy expert for assigned health plans.
  • Represent the health plan during meetings with state regulators.
  • Analyze trends and pharmacy expenditures for advocacy work.
  • Compile and manage pharmacy data for reporting.
  • Oversee centralized pharmacy utilization management team activities.
  • Collaborate with customers to resolve issues and facilitate communications.
  • Ensure compliance with NCQA guidelines and internal policies.

Benefits

  • Flexible remote work options with location requirements in Eastern or Central Time Zone.
  • Access to quality management and health education initiatives.
  • Opportunities for professional development in pharmacy leadership.
  • Supportive environment promoting best practices in member care.
Full Job Description
Job Description

***Remote and must live in the Eastern or Central Time Zone***

JOB DESCRIPTION

Job Summary

Provides deep subject matter expertise and leadership for health plan pharmacy services. Serves as the designated leader for assigned health plan pharmacy program(s) supporting quality, cost-effectiveness, and compliance initiatives. Collaborates with shared services pharmacy leadership to ensure that assigned health plan pharmacy program is consistent with enterprise pharmacy strategy. Contributes to overarching pharmacy strategy for optimization of medication related health care outcomes, and quality cost-effective member care.

Essential Job Duties
• Represents as the assigned pharmacy leader/subject matter expert (SME) for assigned health plan(s).
• Represents health plan at meetings with state regulators as the designated pharmacy representative.
• Performs and compiles analysis on emerging trends, forecasts, and pharmacy spend and uses data in rate advocacy work with the state.
• Collects and compiles pharmacy data for reporting purposes and maintains files of confidential information submitted for review.
• Provides oversight and direction to centralized pharmacy utilization management team.
• Partners with internal and external customers to ensure prompt resolution of identified issues and serve as the first point of contact for internal departments.
• Ensures that pharmacy activities and processes are compliant with National Committee for Quality Assurance (NCQA) guidelines and Molina policies and procedures, and promotes best practice measures to ensure consistency.
• Communicates with practitioners, pharmacists, and drug representatives.
• Advises pharmacy leadership on operational issues, program and system needs, and regulatory changes.
• Supports development of health plan pharmacy-related policies and procedures.
• Participates in quality management and health education programs including, but not limited to NCQA accreditation, Healthcare Effectiveness Data Information Set (HEDIS), and disease management programs.

Required Qualifications
• At least 8 years of experience as a pharmacist, including 5 years of health care delivery experience, or equivalent combination of relevant education and experience.
• At least 3 years of management/leadership experience.
• Active and unrestricted Doctor of Pharmacy (PharmD) in applicable state(s).
• Ability to compile data, create reports, and present information and ideas concisely to varied audiences.
• Strong organizational and time-management skills.
• Ability to develop and maintain positive and effective work relationships with coworkers, members, providers, regulatory agencies, and vendors.
• Excellent verbal and written communication skills.
• Microsoft Office suite and applicable software program(s) proficiency.

Preferred Qualifications
• Managed care or Pharmacy Benefit Management (PBM) experience.
• Knowledge/experience with decision analysis and data analysis tools, such as SQL and Microsoft Excel

To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.

Molina Healthcare offers a competitive benefits and compensation package.

About Molina Healthcare

Molina Healthcare focuses exclusively on government-sponsored health care programs for families and individuals who qualify for government-sponsored health care. It contracts with state governments and serves as a health plan, providing a wide range of quality health care services to families and individuals.

Molina Healthcare Careers

Join the dedicated team at Molina Healthcare, a leader in providing quality healthcare services to families and individuals who qualify for government-sponsored programs, including Medicaid and Medicare. As one of the most respected companies in the health services industry, Molina Healthcare offers unparalleled job opportunities aimed at empowering your career growth and professional development.

Work You’ll Do

At Molina Healthcare, you will engage in meaningful work that directly impacts lives across the country. Our team is committed to innovation in healthcare, ensuring that all members receive the best care possible. By joining us, you will collaborate with skilled professionals dedicated to our mission of providing accessible, high-quality healthcare.

Career Opportunities and Growth

Whether you are looking for your first job, seeking a leadership role, or aiming to specialize in healthcare professions, Molina Healthcare offers a range of career paths. Our job opportunities span across various functions, including clinical services, customer support, IT, project management, and more. We believe in fostering the growth of our employees through professional development, leadership training, and diversity initiatives.

Internship Programs

Kickstart your career with a Molina Healthcare internship. Our internships provide invaluable workplace experience, offering a glimpse into the healthcare industry through hands-on projects and mentorship. Interns at Molina Healthcare gain critical skills that prepare them for future employment, making them competitive candidates in the job market.

Culture and Benefits

Molina Healthcare is not just a company; it’s a community. We prioritize a culture of inclusivity and respect, where all team members are encouraged to bring their whole selves to work. Our employees enjoy comprehensive benefits, including health insurance, retirement plans, and wellness programs, all designed to support both their professional and personal lives.

Join Our Team

Explore the various positions available at Molina Healthcare and find where your skills and interests align with our needs. We are continuously hiring talented individuals who are passionate about making a difference in healthcare. Prepare your resume, sharpen your interview skills, and become part of a team that values hard work and creativity.

Stay Connected

Keep up to date with the latest at Molina Healthcare: - **Career Growth and Networking:** Advance your career through our professional development and networking opportunities. Learn from leaders and peers alike to build connections that propel your career forward. - **Innovation and Leadership:** Drive change and lead with confidence by participating in our leadership and innovation training programs.

Apply Now

Ready to take the next step in your healthcare career? Search open positions that match your skills and interests on the Molina Healthcare Jobs portal. We look for driven, curious, and compassionate team players ready to make an impact.

Stay Informed

Subscribe to Molina Healthcare job alerts and receive updates on new openings and company news directly to your inbox. Tailor your subscription to match your career preferences and stay ahead in the dynamic field of healthcare. Join Molina Healthcare, where your career is nurtured, your contributions are valued, and your growth is guaranteed.
Learn more about Molina Healthcare
Size
14,000 employees
Market Cap
$19.5 billion
Industry
Net Income
$673 million
Founded
1980
5 Year Trend
+9.3%
Revenue
$19.4 billion
NASDAQ

Similar Jobs

More Jobs at Molina Healthcare

More Healthcare Jobs

Find similar Health Plan Pharmacy Services Director jobs: