Representative, Pharmacy - Remote reside

Shift

Monday to Friday: 11:00 AM – 7:30 PM EST

Monday to Friday: 10:00 AM – 6:30 PM PST

Provides customer service support for inbound/outbound pharmacy calls from members, providers, and pharmacies. Contributes to overarching pharmacy strategy for optimization of medication‑related health‑care outcomes and quality cost‑effective member care.

• Handles and records inbound/outbound pharmacy calls from members, providers and pharmacies in accordance with departmental policies, state regulations, National Committee of Quality Assurance guidelines, and Centers for Medicare and Medicaid Services standards.
• Provides coordination and processing of pharmacy prior authorization requests and/or appeals.
• Explains point‑of‑sale claims adjudication, state, NCQA and CMS policies/guidelines, and any other necessary information to providers, members and pharmacies.
• Assists with clerical tasks and other day‑to‑day pharmacy call center 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 members and providers with initiating verbal and written coverage determinations and appeals.
• Records calls accurately within the pharmacy call tracking system.
• Maintains established pharmacy call quality and quantity standards.
• Interacts with appropriate primary care providers to ensure member registry is current and accurate.
• Supports pharmacists with completion of comprehensive medication reviews (CMRs) through pre‑work up to case preparation.
• Proactively identifies ways to improve pharmacy call center member relations.

• At least 1 year related experience, including call center or customer service experience, or equivalent combination of relevant education and experience.
• Excellent customer service skills.
• Ability to work independently on special projects such as pill box requests, case management referrals, over‑the‑counter requests, etc.
• Ability to multi‑task applications while speaking with members.
• Ability to develop and maintain positive and effective work relationships with coworkers, clients, members, providers, regulatory agencies, and vendors.
• Ability to meet established deadlines.
• Ability to function independently and manage multiple projects.
• Excellent verbal and written communication skills, including excellent phone etiquette.
• Proficiency with Microsoft Office suite (including Excel) and applicable software programs.

• Certified Pharmacy Technician (CPhT) and/or state pharmacy technician license (state specific if state required). If licensed, license must be active and unrestricted in the state of practice.
• Health care industry experience.

To all current Molina employees:
If you are interested in applying for this position, please apply through the Internal Job Board.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

• $21.65 – $27.62 per hour.
• Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.