Role Description Molina Healthcare is hiring a Pharmacist in our Utilization Management/Prior Auth department. This position will be working Monday through Friday from 10:00am to 6:30pm CST with rotating weekends and holidays. Candidates can be licensed in any state but will need to be licensed in AZ and NM within 90 days of employment. - 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. - Acts as a liaison between Molina and its customers (members, providers, and pharmacies) with respect to the pharmacy benefit. - Serves as the designated formulary expert. - Ensures Molina is compliant with the coverage determination and appeals process. - 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. - 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 care management department as part of a member-centered interdisciplinary care team (ICT). - 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. - Performs outreach to members and physicians as part of quality and/or cost-control initiatives. - Provides leadership for the pharmacy call center team under the direction of pharmacy senior leadership. - Identifies and implements programs to improve clinical outcomes stemming from medication selection, utilization, and adherence. Qualifications - 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. - Active and unrestricted Doctor of Pharmacy (PharmD) in applicable state(s). - Current knowledge and expertise in clinical pharmacology and disease management. - Ability to present ideas and information concisely to varied audiences. - Knowledge of processes and systems necessary to develop and deliver training to departmental staff and internal customers. - Ability to develop and maintain positive and effective work relationships with coworkers, members, providers, regulatory agencies, and vendors. - Proficiency compiling data, creating reports, and presenting information. - Ability to meet established deadlines. - Functions independently and manages multiple projects. - Excellent verbal and written communication skills. - Microsoft Office suite (including Excel), and applicable software program(s) proficiency. Preferred Qualifications - Medicare Part D and/or Medicaid experience. - Managed care experience. Benefits Molina Healthcare offers a competitive benefits and compensation package. Company Description Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

• Provide integrated support to patients and physicians by providing a "hands-on" approach to improve the quality of patient care. • Reviewing and interpreting clinician's patient care note/assessments for supportive clinical data needed for prior authorization approvals and development of care plan recommendations. • Develop and refine disease and drug specific clinical protocol to maximize patient adherence and promote evidence-based cost-effective care. • Monitor on-going patient adherence (PDC reports, patient assessment data, and mobile platform data) across all sites and disease categories with focus on oncology and other specialty specific disease states. • Evaluation of EMR to review: drug and disease interaction, medication selection, labs/vitals, allergies, RX orders/renewals and direct MD communication, and other relevant information important to maximize medication adherence and optimize patient outcomes. • Recommending alternative therapeutic drug regimens and disease specific treatments according to guidelines as appropriate. • Monitor and evaluate therapies for side effects or other medication related issues, recommend drug therapy changes to prescribers as appropriate. • Medication therapy management (MTM): including reviewing and monitoring of medication regimens, advising clinicians on evidence based therapy as indicated, documenting interventions; assessing patient adherence rates. • Clinical interventions including but are not limited to comprehensive pharmacist consultation, motivational interviewing/coaching, drug regimen optimization, medication reconciliation, medication lists or reminders, medication synchronization, coordinate home nurse visits, transitions between liaison/PSC, use of mobile app or other technologies. • Productivity monitoring and reporting weekly stats for growth development. • Overseeing tech's daily activities and verification for accuracy on: delivery coordination slips, prior authorizations submitted, ongoing PA log activity and proactive management care utilization within each specialty as per protocol. • Identifying and resolving insurance related issues, recognizing situations where financial assistance can be applied. • Supervising communication of support personnel compliant with HIPPA rules and regulations. • Maintaining current registration and all remote pharmacist activity to comply with local, state and federal drug laws as regulated by each state board of pharmacy and the DEA. • Direct communication with other health professionals as necessary regarding patient care. • Develops own knowledge by participating in education programs; training pharmacy staff, students, interns, externs, and health care professionals. • Manage, organize, and update relevant data using database applications. • Apply observations and recommendations to operational issues, increased productivity, quality, and customer-service standards. • Assist with research projects and peer reviewing articles as needed. • Identify trends, resolves problems; recommend improvements; implements change. • Actively participates in process improvement initiatives. • Protects organization's value by keeping information confidential. • Updates job knowledge by participating in educational opportunities; reading professional publications; maintaining personal networks; participating in professional organizations. • Willing to do whatever is necessary for the betterment of the Company.

Role Description We’re an early-stage healthcare team looking for a managed care pharmacist with deep knowledge of how specialty medications are covered under medical and pharmacy benefits. You’ll apply your clinical and managed-care expertise to interpret payer coverage and support the team’s work on patient access. This is a hands-on, individual-contributor role on a small team — a good fit for a pharmacist who likes ownership, variety, and working close to the detail rather than managing others. What You’ll Do - Interpret payer coverage. - Review medical and pharmacy benefit policies and clinical guidelines to understand coverage requirements for specialty medications. - Apply clinical judgment. - Assess coverage criteria such as diagnosis and indication requirements, step therapy, and prior-authorization requirements. - Document Product Requirements clearly. - Summarize coverage findings in a clear, well-organized, well-sourced manner to create product and technical requirements. - Stay current. - Track changes in payer policies and clinical guidelines and regularly update the requirements. - Collaborate cross-functionally. - Work closely with colleagues across the team, including technical development colleagues. - Hold a high bar. - Bring rigor and attention to detail — cite your sources, double-check your work, and flag anything unclear. Qualifications - PharmD, with one or more of the following: - a completed managed-care pharmacy residency; - experience as a prior-authorization pharmacist; - experience as a pharmacist in a managed-care organization (health plan / PBM). - Current U.S. Pharmacist License - Residency or equivalent hands-on experience in coverage / utilization management. - Demonstrated fluency in medical- and pharmacy-benefit coverage: diagnosis and indication requirements, step therapy, prior authorization, and utilization management. - A working understanding of the pharmacy vs. medical benefit distinction and why specialty drugs route to one or the other. - Strong analytical skills and comfort working through dense, unstructured policy material. - Rigorous and source-driven — you cite, you double-check, you sweat the specifics. - Self-directed and energized by a small, fast-moving environment. You want to own your work, not oversee others doing it. - A clear communicator, in writing and in conversation. Preferred Qualifications - Broader experience across specialty pharmacy, market access, payer, or PBM settings. - Comfort working with data and structured information. - Interest in applying clinical expertise in a technology-oriented environment. Benefits - You’ll have real ownership from day one, see your work make a direct difference, and grow with a team at its earliest stage. - If you want scope and the chance to shape your role rather than inherit it, this is that opportunity.

• Serve as the primary point of contact for members, providers, and pharmacies across phone, chat, email, and written correspondence, delivering timely and accurate support regardless of communication channel. • Field and resolve inquiries related to mail order, benefit design, formulary coverage, medication cost, prior authorization criteria, and claims adjudication. • Seamlessly support interactions across phone, chat, email, and other digital channels while maintaining consistent quality and service standards. • Assist network pharmacies in processing prescription claims, reviewing claims for accuracy against benefit guidelines and contract standards. • Support clinical pharmacists with patient and provider outreach, including scheduling appointments, enrolling members in Rightway clinical programs, and following up on medication adherence. • Accurately document interactions and resolutions within internal systems to support continuity of care, quality assurance, compliance requirements, and operational reporting. • Take ownership of member, provider, and pharmacy issues from initial contact through final resolution, coordinating with internal teams when necessary to ensure timely and complete resolution. • Utilize AI-enabled tools and internal knowledge systems to efficiently resolve inquiries, document interactions, and deliver a consistent member experience. • Foster a team environment that values cooperation, respect, and diversity, and take on other duties and projects as assigned.