Molina Healthcare

Pharmacist, Utilization Management/Prior Auth (Remote)

Molina Healthcare • $100K — $130K *
Long Beach, CA 90802In-Person
Pharmaceuticals & Biotech
Less than 5 years of experience
Today
Be an Early Applicant
Job Overview by Ladders

Qualifications

  • 3+ years in pharmacy, PBM, formulary, or managed care; 1-2 years post-graduate experience or equivalent.
  • Active, unrestricted PharmD license in applicable states; must obtain AZ and NM licenses within 90 days.
  • Strong clinical pharmacology and disease management expertise.
  • Effective communicator; able to present ideas clearly to diverse audiences.
  • Experience developing and delivering training for staff and internal stakeholders.
  • Skill in compiling data and creating informative reports.
  • Proficient with Microsoft Office, particularly Excel, and relevant software.

Responsibilities

  • Provide subject matter expertise for pharmacy formulary liaison activities.
  • Serve as the liaison between Molina and its customers regarding pharmacy benefits.
  • Act as the designated formulary expert for Molina.
  • Ensure compliance with coverage determination and appeals processes.
  • Contribute to projects enhancing quality metrics like STAR ratings and HEDIS.
  • Assist call center pharmacy technicians with clinical inquiries and calls.
  • Develop and maintain pharmacy cost-control and quality initiatives.

Benefits

  • Competitive benefits package offered by Molina Healthcare.
Full Job Description
Job Description

Molina Healthcare is hiring a Pharmacist in our Utilization Management/Prior Auth department.
This position will be working Monday through Friday from 10:00am to 6:30pm CST with rotating weekends and holidays.
Candidates can be licensed in any state but will need to be licensed in AZ and NM within 90 days of employment.

Essential Job Duties
  • Provides support and subject matter expertise for pharmacy formulary liaison activities between the business and its customers (members, providers and pharmacies) to determine coverage and informative drug use. Contributes to overarching pharmacy strategy for optimization of medication related health care outcomes, and quality cost-effective member care.
  • Acts as a liaison between Molina and its customers (members, providers and pharmacies) with respect to the pharmacy benefit.
  • Serves as the designated formulary expert.
  • Ensures Molina is compliant with the coverage determination and appeals process.
  • Contributes to projects aimed at improving STAR ratings, Healthcare Effectiveness Data Information Set (HEDIS), Consumer Assessment of Healthcare Providers and Services (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 care management department as part of a member-centered interdisciplinary care team (ICT).
  • Works with the Pharmacy Benefit Manager (PBM) to manage formulary changes and update marketing on any changes needed on the web or print versions of the formulary.
  • Performs outreach to members and physicians as part of quality and/or cost-control initiatives.
  • Provides leadership for the pharmacy call center team under the direction of pharmacy senior leadership.
  • Identifies and implements programs to improve clinical outcomes stemming from medication selection, utilization, and adherence.

Required Qualifications
  • At least 3 years of experience in a pharmacy, Pharmacy Benefit Manager(PBM), formulary, and/or managed care setting, and 1-2 years post-graduate experience, or equivalent combination of relevant education and experience.
  • Active and unrestricted Doctor of Pharmacy (PharmD) in applicable state(s). • Current knowledge and expertise in clinical pharmacology and disease management.
  • Ability to present ideas and information concisely to varied audiences.
  • Knowledge of processes and systems necessary to develop and deliver training to departmental staff and internal customers.
  • Ability to develops and maintains positive and effective work relationships with coworkers, members, providers, regulatory agencies and vendors.
  • Proficiency compiling data, creating reports and presenting information.
  • Ability to meet established deadlines.
  • Functions independently and manages multiple projects.
  • Excellent verbal and written communication skills.
  • Microsoft Office suite (including Excel), and applicable software program(s) proficiency.

Preferred Qualifications
• Medicare Part D and/or Medicaid experience.
• Managed care experience.

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
Healthcare
Net Income
$673 million
Founded
1980
5 Year Trend
+9.3%
Revenue
$19.4 billion
NASDAQ
MOH
* Ladders Estimates

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