Remote Pharmacist, Quality Withhold Clinical/Medication Therapy Management

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. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V