Molina Healthcare

Remote Pharmacist, Quality Withhold Clinical/Medication Therapy Management

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

Qualifications

  • 3+ years in pharmacy, MTM, PBM, or managed care
  • Active and unrestricted PharmD license
  • Strong clinical pharmacology understanding
  • Experience with Medication Therapy Management best practices
  • Proficiency in Microsoft Office and reporting tools
  • Excellent communication skills
  • Ability to manage multiple projects independently

Responsibilities

  • Provide subject matter expertise for pharmacy MTM and clinical services
  • Facilitate comprehensive medication reviews and member outreach
  • Analyze medication profiles for safety and compliance
  • Promote appropriate prescribing practices based on guidelines
  • Conduct prior authorization reviews for high-cost medications
  • Collaborate with interdisciplinary teams for member care
  • Develop drug utilization strategies and intervention techniques

Benefits

  • Remote work option during Eastern Standard Hours
  • Supportive work environment fostering collaboration
  • Opportunities for professional development
  • Access to comprehensive health and wellness programs
  • Participation in a company with a community-focused mission
Full Job Description
Job Description

Molina Healthcare is hiring for a Pharmacist, Quality Withold in our Clinical/Medication Therapy Management department.
This position is remote but will work Eastern Standard Hours.

This role will be reviewing quality measures for Massachusetts.

Highly qualified candidates will have a background in Managed Care, Adherence, Medicaid, and/or Quality Withhold.

Provides support and subject matter expertise for pharmacy Medication Therapy Management (MTM) and clinical pharmacy services activities. Contributes to overarching pharmacy strategy for optimization of medication related health care outcomes, and quality cost-effective member care.

Essential Job Duties
  • Provides support and subject matter expertise for pharmacy Medication Therapy Management (MTM) and clinical pharmacy services activities. Contributes to overarching pharmacy strategy for optimization of medication related health care outcomes, and quality cost-effective member care.
  • Facilitates Medication Therapy Management (MTM) support including examination of member medical records, comprehensive medication reviews, and communication with members and providers (includes outbound calls to members to discuss medications).
  • Reviews member medication profiles and applies evidence-based medicine and national guidelines when creating recommendations for health care providers for optimization of member medication regimens.
  • Analyzes and reviews medication lists for potential patient safety issues, 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 interventions).
  • Articulates pharmacy management policies and procedures to pharmacy/health plan providers, Molina staff and others as needed.
  • 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 health care.
  • Assists in coordination of care for pharmacy-related issues between members, providers and other members of the member's interdisciplinary care team (ICT), including referrals to state plan healthcare 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 (PBM) reports to track general trends in drug utilization and identify potential targeted utilization management activities.
  • Works with healthcare services team (e.g., data managers, care managers, etc.) on member-centered interdisciplinary teams.
  • May prepare drug monographs and utilization reports for the Pharmacy and Therapeutics (P&T) committee.
  • Assists leadership in developing/updating policies and procedures, and implementing changes to comply with state and federal regulations.

Required Qualifications
  • At least 3 years of experience in a pharmacy, Medication Therapy Management (MTM), Pharmacy Benefit Manager(PBM), and/or managed care setting, or equivalent combination of relevant education and experience.
  • Doctor of Pharmacy (PharmD). License must be active and unrestricted in applicable state(s) of practice.
  • Demonstrated knowledge and expertise in clinical pharmacology and disease management.
  • Clinical skills related to Medication Therapy Management (MTM). • Demonstrated knowledge of best practices in Medication Therapy Management Program (MTMP) related disease states.
  • 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, and ability to develop and deliver necessary training to departmental staff and internal customers.
  • Ability to develops and maintain positive and effective work relationships with coworkers, members, providers, regulatory agencies and vendors.
  • Proficiency in 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
  • Board Certified Ambulatory Care Pharmacist (BCACP).
  • American Pharmacist's Association Medication Therapy Management (MTM) certificate.
  • Medicaid and/or Medicare experience.
  • Clinical skills or pharmacotherapy expertise for Medication Therapy Management Programs (MTMP) related conditions and medications.
  • Experience with team-based care.

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

Molina Healthcare offers 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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