Pharmacist, Utilization Management (UM)

JOB DESCRIPTION Job Summary 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. Essential Job Duties u2022 Acts as a liaison between Molina and its customers (members, providers and pharmacies) with respect to the pharmacy benefit. u2022 Serves as the designated formulary expert. u2022 Ensures Molina is compliant with the coverage determination and appeals process. u2022 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. u2022 Assists call center pharmacy technicians with clinical questions and phone calls from prescribers, pharmacies and/or members. u2022 Develops, implements and maintains pharmacy cost-control and quality initiatives under the direction of leadership. u2022 Monitors drug utilization and assists leadership team in understanding quality and cost-control issues related to pharmacy. u2022 Works in tandem with Molina medical directors to ensure accurate coverage determination decisions. u2022 Works with leadership on developing annual training sessions for applicable staff regarding the pharmacy benefit changes for the upcoming year. u2022 Works with the care management department as part of a member-centered interdisciplinary care team (ICT). u2022 Works with the Pharmacy Benefit Manager (PBM) to manage formulary changes and update marketing on any changes needed on the web or print versions of the formulary. u2022 Performs outreach to members and physicians as part of quality and/or cost-control initiatives. u2022 Provides leadership for the pharmacy call center team under the direction of pharmacy senior leadership. u2022 Identifies and implements programs to improve clinical outcomes stemming from medication selection, utilization, and adherence. Required Qualifications u2022 At least 3 years of experience in a pharmacy, Pharmacy Benefit Manager(PBM), formulary, and/or managed care setting, and 1-2 years post-graduate experience, or equivalent combination of relevant education and experience. u2022 Active and unrestricted Doctor of Pharmacy (PharmD) in applicable state(s). u2022 Current knowledge and expertise in clinical pharmacology and disease management. u2022 Ability to present ideas and information concisely to varied audiences. u2022 Knowledge of processes and systems necessary to develop and deliver training to departmental staff and internal customers. u2022 Ability to develops and maintains positive and effective work relationships with coworkers, members, providers, regulatory agencies and vendors. u2022 Proficiency compiling data, creating reports and presenting information. u2022 Ability to meet established deadlines. u2022 Functions independently and manages multiple projects. u2022 Excellent verbal and written communication skills. u2022 Microsoft Office suite (including Excel), and applicable software program(s) proficiency. Preferred Qualifications u2022 Medicare Part D and/or Medicaid experience. u2022 Managed care experience. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $80,412 - $188,164 / ANNUAL Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Created: 2025-10-09