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).
The Director, Health Plan Pharmacy Services is the clinical and business leader for Molina Pharmacy and Medicare Part D services within the Health Plan. This is an integral role of the Medical Affairs leadership team, assisting the team in understanding Medicare pharmacy quality, cost effectiveness and compliance and working closely with Pharmacy leadership to ensure that the Medicare Pharmacy Program is consistent with Molina's overall pharmacy strategy.
• Provides clinical, administrative, strategic, financial and regulatory management of Medicare pharmacy and Medicare Part D services, including effectively managing pharmacy clinical services, costs and prescription drug utilization and maintaining compliance with all applicable regulations.
• Provides strategic leadership and vision for the Medicare pharmacy group to ensure high performance, quality oriented and cost effective programming.
• Provides oversight for the Pharmacy Prior Authorization Unit and is accountable for meeting performance goals.
• Supports Pharmacy cost effectiveness goals by developing and implementing cost control initiatives and reporting. Shares accountability for meeting budget goals for Pharmacy costs.
• Supports Formulary design and development, revisions, implementation and Risk Score Management.
• In collaboration with Corporate Pharmacy, supervises and monitors Molina's contracted Pharmacy Benefit Manager (PBM) for pharmacy contractually delegated functions.
• Participates in Quality Management and Health Education programs to include NCQA Accreditation, HEDIS, and Disease Management programs company-wide.
• 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.
• Min. 7-9 years in the healthcare industry, managed care organization or equivalent experience.
• Min. 3 years experience working in a managed care setting with formularies, drug utilization review, utilization management and clinical management of patients.
• Previous management experience in healthcare.
Required License, Certification, Association
• Licensed to practice Pharmacy in the applicable State.
• Must be free of sanctions from Medicaid or any other government program and without restrictions that would affect job performance.
• Doctorate in Pharmacy (PharmD)
• Completion of an accredited residency program
• Experience in Medicaid or other Government-sponsored programs.
Preferred License, Certification, Association
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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