Molina Healthcare Account Mgr, Pharmacy Benefits Mgmt_Pharmacy_Remote Employees in United States
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 with regard to patient outcomes, medications safety and medication use policies).
Knowledge/Skills/Abilities • Monitors and manages the operational aspects of the contract with Pharmacy Benefits Manager to assure contract compliance and maximize value.
• Perform cost/utilization analysis leading to assist in the identification of management opportunities to improve the cost/quality of healthcare.
• Oversees processes and implements solutions necessary to collect overpayments, recoveries, and all other issues.
• Collaborate with other departments to secure the data and analysis necessary to support state rate setting and to coordinate on pharmacy-related eligibility issues, including COB processes and encounter reporting.
• Monitor MAC Pricing Lists at health plan levels for changes and to assure contract compliance; collaborate with clinical teams to develop solutions.
• Oversee, support and perform all audits as required (SOX, CMS, internal, Network).
• Reconcile rebates receivable in collaboration with Accounting.
• Provide leadership for any state PBM compliance issues identified. Job Qualifications Required Education
Associate's Degree or equivalent combination of education and experience
5+ years managed care pharmacy or PBM experience.
Required License, Certification, Association
State Pharmacy Technician license
Bachelor of Science Degree
Prior operational experience executing PBM and Specialty Pharmacy contracts on behalf of large payer(s).
Preferred License, Certification, Association
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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