Remote Utilization Review Rn Jobs in Boca Raton, FL

Molina Healthcare is hiring for a Pharmacist in our UM/Prior Authorization department. This position is remote and can be worked from a variety of locations within the US.

Shift times can be either 8 or 10 hour shifts between the times of 7a and 10p EST with rotating weekends depending on business needs.

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 regarding patient outcomes, medications safety and medication use policies).

KNOWLEDGE/SKILLS/ABILITIES

The Pharmacist, UM will be responsible for reviewing coverage determinations and appeals in a timely, compliant, and accurate manner. The Pharmacist, UM will also be responsible for serving as a formulary and drug information resource, assisting technicians and other departments with questions regarding drug coverage.

• Acts as a liaison between Molina and its customers (members, providers and pharmacies) with respect to the pharmacy benefit. 
• Serves as the formulary expert.
• Ensures Molina is compliant with the coverage determination and appeals process.
• Contributes to projects aimed at improving Star ratings, HEDIS, 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 initiatives under the direction of leadership.
• Monitors drug utilization and assists leadership team in understanding quality and cost control issues related to pharmacy.
• Works in tandem with Molina Medical Directors to ensure accurate coverage determination decisions.
• Works with leadership on developing annual training sessions for applicable staff regarding the pharmacy benefit changes for the upcoming year.
• Works with the Case Management department as part of a member-centered interdisciplinary care team.
• Works with the PBM to manage formulary changes and update marketing on any changes needed on the web or print versions of the formulary.
• Performs outreach to patients and physicians as part of quality and/or cost control initiatives.
• Provides leadership for the pharmacy call center team as delegated by the Manager.
• Identifies and implements programs to improve clinical outcomes stemming from medication selection, utilization, and adherence.

JOB QUALIFICATIONS

Required Education

• Doctor of Pharmacy or bachelor’s degree in pharmacy with equivalent experience.
• Continuing education required to maintain an active pharmacist license.                                                                                                

Required Experience: 1 - 2 years post-graduate experience.

Required License, Certification, Association: Active and unrestricted State Pharmacy License for workplace and plan location.

Preferred Experience

• Medicare Part D or Medicaid experience.
• Managed care experience.

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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Pay Range: $80,412 - $156,803.45 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.