Remote Pharmacist, Quality Withhold Clinical/Medication Therapy Management

About the role

Molina Healthcare is hiring for a Pharmacist, Quality Withold in their Clinical/Medication Therapy Management department. This position is remote but works Eastern Standard Hours. The role will review quality measures for Massachusetts.

Responsibilities

• Supports and provides subject matter expertise for pharmacy Medication Therapy Management (MTM) and clinical pharmacy services activities.
• Contributes to the pharmacy strategy for optimizing medication-related health care outcomes and providing quality, cost-effective member care.
• Facilitates Medication Therapy Management (MTM) support by examining member medical records, conducting comprehensive medication reviews, and communicating with members and providers (including outbound calls).
• Reviews member medication profiles and applies evidence-based medicine and national guidelines to create recommendations for healthcare providers.
• Analyzes and reviews medication lists for potential patient safety issues, such as drug interactions and suboptimal regimens.
• Promotes clinically appropriate prescribing practices based on evidence-based medicine and national guidelines through various modalities.
• Performs prior authorization reviews of high-cost medications and deferred authorization requests as needed.
• Develops and implements drug utilization and disease state management strategies and intervention techniques to deliver high-quality, cost-effective health care.
• Aids in coordinating 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 ensure 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 drug utilization trends 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.

Requirements

• 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.
• Knowledgeable in clinical skills related to Medication Therapy Management (MTM).
• Current knowledge and expertise in clinical pharmacology and disease management.
• Ability to present ideas and information concisely to varied audiences.
• Proficient in processes and systems, and able to develop and deliver necessary training to departmental staff and internal customers.
• 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.
• 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.