|Category:||Life Sciences/Healthcare : Hospital/Health Systems|
Position Pharmacy Director, Corporate Services
Company Molina Healthcare
Location Louisville, KY
Reporting Relationship The Pharmacy Director, Corporate Services will report to the CMO Medical Director
MOLINA HEALTHCARE – BACKGROUND AND CULTURE
Molina Healthcare, Inc., a FORTUNE 500 company, provides managed health care services under the Medicaid and Medicare programs and through the state insurance marketplaces. Through its locally operated health plans, Molina Healthcare currently serves approximately 4.1 million members.
Molina’s businesses include:
Molina Health Plans
Medicaid Molina Healthcare contracts with state governments and serves as a health plan, providing a wide range of quality health care services to families and individuals who qualify for government-sponsored programs, including Medicaid and the State Children's Health Insurance Program (SCHIP). Molina Healthcare offers Medicaid plans in California, Florida, Illinois, Kentucky, Michigan, Mississippi, New Mexico, New York, Ohio, Puerto Rico, South Carolina, Texas, Utah, Washington and Wisconsin.
Molina Healthcare offers Medicare Advantage plans designed to meet the needs of individuals with Medicare or both Medicaid and Medicare coverage. Molina Medicare plans offer comprehensive, quality benefits and programs including access to a large selection of doctors, hospitals and other health care providers at little or no out-of-pocket cost.
Integrated Medicaid/Medicare (Duals)
Molina Healthcare has been selected for several duals demonstration projects as part of a member-centered health care approach for people who are eligible for both Medicaid and Medicare. Molina has already been working with these members through our Medicaid and Medicare health plans for many years, and this experience will help us provide these members with high quality care that meets their unique needs.
Molina Healthcare offers Marketplace (known as Exchange in some states) plans in many of the states where we offer Medicaid health plans. Our plans allow our Medicaid members to stay with their providers as they transition between Medicaid and the Marketplace. Additionally, they remove financial barriers to quality care and keep members’ out-of-pocket expenses to a minimum.
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).
• Provides oversight and vendor management of Molina Healthcare's contracted pharmacy benefits management (PBM) program.
• Monitors PBM performance with contract requirements, pricing, rebate and performance guarantees.
• Maintains contract oversight and audit of PBM, including regulatory compliance, delegation responsibilities, escalated issues resolution and dual coverage implementation.
• Serves as lead resource to address emerging PBM contractual service issues or business development, including Mail Services and Specialty Pharmacy.
• Serves as a subject matter expert and resource for PBM Account Managers, including training, support and regular oversight of PBM adherence to contract requirements.
• Monitors drug utilization patterns for Molina Healthcare and assists in the development, implementation and supervision of programs to promote cost-effective pharmacotherapy and drug safety.
• Works with PBM and company resources to improve analytics and reporting that result in improved Medicare executive and State Plan-specific reporting to evaluate cost and utilization opportunities.
• Participates on the Pharmacy and Therapeutics Policy Committee and other clinical committees, as needed.
• Provides leadership for the Molina PBM Work Change Committee.
• Supports development and maintenance of network and specialty pharmacy pricing.
• Doctor of Pharmacy from an accredited pharmacy school or Bachelor's Degree in Pharmacy with equivalent experience.
• Continuing education required to maintain an active pharmacist license.
• Min. 7-9 years in the health care industry, managed care organization or equivalent experience.
• Prior work experience with vendors, outside contacts and other health care professionals to accomplish responsibilities.
• Knowledge of computer data extracting methods.
• Strong knowledge of pharmacological management of chronic disease states.
• Demonstrating experience managing multiple simultaneous projects and prioritizing functions.
Required License, Certification, Association
• Licensed to practice Pharmacy in the U.S.
• Must be free of sanctions from Medicaid or any other government program and without restrictions that would affect job performance.
• Doctorate in Pharmacy (PharmD)
• Completion of an accredited residency program Preferred Experience
• Managed care or PBM pharmacy experience.
• Experience in Government-sponsored programs.
• Project Manager experience.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.