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Molina Healthcare Clinical Pharmacist Pharmacy Policy Remote in United States ID-15470

The Clinical Pharmacist, Pharmacy Policy is responsible for the identification, execution, and follow-up on high cost medication usage evaluations and recommendations for the Molina Healthcare, Inc. patient population. The goal of this role is to guide the organization to provide timely, appropriate, and cost-effective drug therapy to our patients. Leads the charge by analyzing pharmaceutical usage and cost trends and work with the appropriate state health plan parties to develop and/or administer state government clinical initiatives focusing on methods to achieve cost reduction around targeted therapies.

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Responsible for monitoring of state government changes and putting new policies in-place and educating staff and physicians on the approach and to ensure the processes, programs and services are accomplished in a timely and efficient manner. Additionally, providing clinical support and oversight for all utilization management (UM) activities on an ongoing basis, in accordance with Molina Healthcare Inc. policies and procedures and in compliance with applicable state and federal regulations, as well as accreditation standards such as NCQA.

Job Duties

  • Develops, manages, and evaluates new and existing drugs utilization management. In addition, provides clinical support oversight over PBM clinical programs and medication therapy program.

  • Supports Pharmacy leadership in the formulation and integration of pharmacy clinical programs.

  • Provides support to pharmacy work groups, best practices, and forums

  • Support new business implementation of establishment of medical drug benefit

  • Provides support to Payment Integrity for pre-payment policy reviews

  • Develops guidance documents for best practice in medical drug management in efforts with other key stakeholders to support medical drug provider contracts, medical drug configuration, and medical drug encounters

  • Maintains oversight for third party vendors for pre-pay clinical edits of medical drug policies and presents a clinical governance when necessary

  • Develop drug product review and recommendations by assessing drug use trends, new drug releases and review of primary literature. Prior experience in drug policy analysis and drug formulary management highly preferred.

  • Critically evaluate and interpret data from various sources to provide an accurate and balanced response within the guidelines and regulations of industry-based drug information practice.

  • Set criteria for medication review of non-formulary or non-preferred drug list medications and communicate recommendations.

  • Research drug information to maintain drug knowledge and disease state understanding. Monitor pipeline medications and new medication research.

  • Provide support documentation and develop communication for the Policy Voting and National Pharmacy & Therapeutics (P&T) Committee review process and decisions.

  • Provide education to physicians, nurses, pharmacists and allied health care professionals regarding safe medication use or changes in medication policy. Triage and respond to drug information inquiries from physicians, pharmacists, nurses and other health care professionals. Some patient correspondence may occur.

     

  • Assist with training of pharmacy students and with continuing education activities for pharmacy staff.

  • Review drug usage data and make determinations for drug products according to member benefits and coverage criteria.

  • Complete projects related to clinical pharmacy and medication use improvement, as needed.

  • Assist with implementation and education of best practice alerts, updating drug lists, and other work related to medication use

  • Reviewing and revising scripting for patient and prescriber communication (e.g., criteria, letters) related to drug coverage and other drug utilization programs.

  • Create, develop, implement, and monitor clinical programs to improve Molina Healthcare’s quality of service

  • Effectively communicate with various healthcare professionals internally and externally for successful collaboration and implementation of initiatives.

  • Design studies and analyze data to measure clinical program outcomes.

  • Understand utilization and quality management techniques, drug trends, and issues in industry to effectively develop and implement strategies to improve health outcomes while reducing cost.

  • Support other clinical programs cross-functionally aimed at improving quality measures and/or compliance requirements.

  • Supports Pharmacy leadership in all clinical functions including but not limited to Prior Approval policy creation and maintenance.

  • Supports the direction for Molina Healthcare’s prescription drug benefit programs and initiatives to promote the cost-effective use of pharmaceuticals.

  • Provides support in the development, management and evaluation of plan formularies

Job Qualifications

REQUIRED EDUCATION :

  • Doctor of Pharmacy from an accredited pharmacy school or bachelor’s degree in Pharmacy with equivalent experience

  • Continuing education required to maintain an active pharmacist license

REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES :

  • 3+ years in the health care industry, managed care organization or equivalent experience

  • Strong knowledge of pharmacological management of chronic disease states

  • Strong comfort level of data analysis, prior knowledge of high cost drug classes, strong analytical skills and an ability to lead at a cross-functional level by stewarding recommendations forward within various leadership forums

REQUIRED LICENSE, CERTIFICATION, ASSOCIATION :

  • Licensed to practice Pharmacy in the US

  • Must be free of sanctions from Medicaid, or any other government program, and without restrictions that would affect job performance

PREFERRED EDUCATION :

PREFERRED EXPERIENCE :

  • 5+ years

  • Prior work experience with vendors, outside contacts and other health care professionals to accomplish responsibilities

  • Knowledge of computer data extracting methods

  • Demonstrated experience managing multiple, simultaneous projects and prioritizing functions

  • Managed care or PBM pharmacy experience

  • Experience in government-sponsored programs

  • Analytic experience

  • Medical drug experience

  • Residency

  • Management experience

  • MS Excel knowledge- Advanced (e.g., formulas, pivot tables, lookup functions)

Pay Range: $80,412 – $156,803 a year*

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

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.

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