Job Description

Job Summary

The Clinical Formulary Pharmacist works to ensure that Molina members have access to all medically necessary prescription drugs and those drugs are used in a cost-effective, safe manner. The Clinical Formulary Pharmacist is responsible for creating, operating, and monitoring Molina Health Plan's pharmacy benefit programs in accordance with all federal and state laws. This may include 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 with regard to patient outcomes, medications safety and medication use policies).

Job Duties

Responsible for maintaining clinically sound and cost-effective formularies across multiple states Lead formulary operations related to weekly drug file updates, ad hoc configuration changes, and quarterly Pharmacy and Therapeutics Committee decisions, including all applicable regulatory requirements pertaining to member and provider notification. Collaborate with state agencies, analytics, finance, government affairs, pharmacy benefit manager, and other cross-functional areas to ensure compliant implementation and maintenance of all formularies Responds to internal/external audits and surveys related to formulary functions, and develops corrective actions or process improvements, including documentation of required activities Subject matter expert on all regulatory requirements related to drug formularies and pharmacy operations Performs oversight of vendor activities related to business functions and operations Defines and enhances business requirements to support efficient formulary submissions, reporting, external member/provider communication and web publishing Support the Molina Health Plan pharmacy executives to ensure they have analysis-based justification for the launch/continuation of pharmacy cost management strategic initiatives Analyze dashboards/reports to support effective tracking of performance and outcomes in connection with pharmacy cost management strategies

Job Qualifications

Required Education:

Doctor of Pharmacy (Bachelor’s in Pharmacy plus 10 years of relevant experience, including clinical work, will be considered in lieu of Pharm.D.) Continuing education required to maintain an active pharmacist license

Preferred Education:

Post graduate education or certification

Required Experience:

2+ years pharmacy benefit design, formulary, and configuration experience at a health plan, PBM, pharmacy or pharmacy consulting firm 2+ years of experience in coordinating activities that span multiple departments in a highly matrixed organization

Required Knowledge, Skills, and Abilities:

Expert level of proficiency in clinical pharmacy, Rx cost management strategies performing financial impact analysis, data manipulation and using MS Excel

Required License, Certification, Association:

Active and unrestricted license to practice Pharmacy in the U.S.

Preferred Qualifications:

Experience using relational databases

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.