Remote Pharmacist – Prior Authorization & Utilization Management

About the role

Molina Healthcare is seeking a remote Pharmacist to join its Utilization Management (UM) and Prior Authorization team. The pharmacist will ensure members receive medically necessary prescription drugs while supporting cost‑effective and safe medication use.

Key responsibilities

• Review coverage determinations, prior authorizations, and appeals promptly and accurately.
• Serve as a formulary and drug‑information resource for technicians, providers, and other departments.
• Act as liaison between Molina, members, providers, and pharmacies regarding pharmacy benefits.
• Support call‑center pharmacy technicians with clinical questions and prescriber or member calls.
• Develop, implement, and maintain pharmacy cost‑control and quality initiatives.
• Monitor drug utilization and assist leadership in quality and cost‑control analysis.
• Collaborate with Medical Directors, Case Management, and PBM on coverage decisions and formulary updates.
• Participate in outreach to patients and physicians for quality and cost‑control projects.
• Provide leadership to the pharmacy call‑center team as delegated.

Required profile

• Doctor of Pharmacy (Pharm.D.) degree.
• Active pharmacy license in the United States.
• Experience in utilization management, prior authorization, or formulary management preferred.
• Strong knowledge of federal and state pharmacy regulations.

Required skills

• Prior authorization review
• Formulary management
• Therapeutic drug monitoring
• Drug utilization review
• Clinical pharmacy services