Pharmacist, Utilization Management (Remote)

Job description

Molina Healthcare is hiring for a remote Pharmacist, UM/Prior Auth. 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. The hours will be Monday through Friday 10am- 630 central time with rotating weekends. - 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 initi...