Representative, Pharmacy - Remote reside in EST, PST or MST

Location

Remote. Eligible locations:
Florida, Washington, Utah, New Mexico, Idaho, Nevada, Arizona, Nebraska.

M-F 11:00‑07:30

EST; 10:00‑06:30

PST.

Provides customer service support for inbound and 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 and outbound pharmacy calls in accordance with departmental policies, state regulations, NCQA guidelines, and CMS standards.
• Provides coordination and processing of pharmacy prior‑authorization requests and appeals.
• Explains point‑of‑sale claims adjudication, state, NCQA and CMS policies, and 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 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 of related experience, including call center or customer service experience, or an 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, and over‑the‑counter requests.
• 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 program(s).

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

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

Molina Healthcare offers a competitive benefits and compensation package.

EOE M/F/D/V