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Molina Healthcare Rep, Pharmacy in Midvale, Utah

Rep, Pharmacy

Molina Healthcare

Job ID 2003947

Job Description

Job Summary

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

• Handles and records inbound pharmacy calls from members, providers and pharmacies to meet departmental and CMS standards.

• Provides coordination and processing of pharmacy prior authorization requests and/or appeals.

• Explains Point of Sale claims adjudication, state CMS policy/guidelines, and any other necessary information to providers, members and pharmacies.

• Assists with clerical services/tasks and other day-to-day operations as delegated.

• Effectively communicates plan benefit information, including but not limited to, formulary information, copay amounts, pharmacy location services and prior authorization outcomes.

• Assists member and providers with initiating oral and written coverage determinations and appeals.

• Records calls accurately in call tracking system.

• Maintains specific quality and quantity standards.

Job Qualifications

Required Education

High School Diploma or GED equivalent

Required Experience

1-3 years of call center or customer service experience

Preferred Education

Associate's Degree

Preferred Experience

3-5 years; healthcare industry experience preferred

Preferred License, Certification, Association

N/A

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.

About Us

Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Job Type: Full Time

Posting Date: 01/11/2021

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