Customer Service Representative, Medicare Pharmacy
Molina Healthcare Arizona; Racine, Wisconsin; Provo, Utah; Davenport, Iowa; Florida; Tampa, Florida; New Mexico; Madison, Wisconsin; Las Cruces, New Mexico; Roswell, New Mexico; Syracuse, New York; Lexington-Fayette, Kentucky; Cincinnati, Ohio; Kenosha, Wisconsin; Georgia; Akron, Ohio; Salt Lake City, Utah; West Valley City, Utah; Iowa; Omaha, Nebraska; Grand Rapids, Michigan; Warren, Michigan; Albuquerque, New Mexico; Lincoln, Nebraska; Tucson, Arizona; Santa Fe, New Mexico; Chandler, Arizona; Louisville, Kentucky; Scottsdale, Arizona; Meridian, Idaho; Jacksonville, Florida; Caldwell, Idaho; New York, New York; Iowa City, Iowa; Yonkers, New York; Rio Rancho, New Mexico; Ann Arbor, Michigan; Kentucky; Bowling Green, Kentucky; Orlando, Florida; Miami, Florida; Atlanta, Georgia; Augusta, Georgia; St. Petersburg, Florida; Bellevue, Nebraska; Savannah, Georgia; Idaho Falls, Idaho; Boise, Idaho; New York; Dallas, Texas; Nebraska; Nampa, Idaho; San Antonio, Texas; Washington; Texas; Seattle, Washington; Phoenix, Arizona; Milwaukee, Wisconsin; Macon, Georgia; Austin, Texas; Owensboro, Kentucky; Cedar Rapids, Iowa; Orem, Utah; Michigan; Green Bay, Wisconsin; Utah; Wisconsin; Spokane, Washington; Ohio; Mesa, Arizona; Layton, Utah; Cleveland, Ohio; Vancouver, Washington; Detroit, Michigan; Covington, Kentucky; Des Moines, Iowa; Sioux City, Iowa; Idaho; Kearney, Nebraska; Buffalo, New York; Columbus, Ohio; Columbus, Georgia; Rochester, New York; Dayton, Ohio; Houston, Texas; Grand Island, Nebraska; Bellevue, Washington; Fort Worth, Texas; Sterling Heights, Michigan; Tacoma, Washington Job ID 2029471JOB DESCRIPTION
Job Summary
Molina Pharmacy Services/Management staff work to ensure that Molina members, providers, and pharmacies 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 regarding 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, State regulations, NCQA guidelines, and CMS standards.
- Provides coordination and processing of pharmacy prior authorization requests and/or appeals.
- Explains Point of Sale claims adjudication, state, NCQA, and 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 degree
Preferred Experience
- 3-5 years; healthcare industry experience preferred
- National pharmacy technician certification
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.
Pay Range: $21.16 - $24.02 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
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: 01/11/2025ABOUT OUR LOCATION
View Map- Sr Spc, Growth & Comm Engagement (Bilingual Cantonese, San Gabriel Valley) San Gabriel California, Long Beach California, Los Angeles California, Pomona California 02/15/2025
- Program Manager, HCS (Remote) Arizona, Houston Texas, Green Bay Wisconsin, Dallas Texas, Cedar Rapids Iowa, Wisconsin, Boise Idaho, Santa Fe New Mexico, Seattle Washington, Las Cruces New Mexico, Meridian Idaho, Warren Michigan, Buffalo New York, Bellevue Nebraska, Idaho, Dayton Ohio, Nampa Idaho, Louisville Kentucky, Nebraska, Utah, Georgia, Augusta Georgia, Cleveland Ohio, Iowa City Iowa, Miami Florida, Sioux City Iowa, Milwaukee Wisconsin, Spokane Washington, Tucson Arizona, Macon Georgia, Caldwell Idaho, Des Moines Iowa, Chandler Arizona, Syracuse New York, Provo Utah, Grand Island Nebraska, Orlando Florida, Bowling Green Kentucky, Rio Rancho New Mexico, Akron Ohio, Yonkers New York, West Valley City Utah, Michigan, Savannah Georgia, Columbus Ohio, Lincoln Nebraska, Kentucky, Roswell New Mexico, Idaho Falls Idaho, Detroit Michigan, Owensboro Kentucky, Racine Wisconsin, Cincinnati Ohio, Orem Utah, Lexington-Fayette Kentucky, New Mexico, Tacoma Washington, Austin Texas, St. Petersburg Florida, New York New York, Washington, Albuquerque New Mexico, Salt Lake City Utah, Kearney Nebraska, Kenosha Wisconsin, Davenport Iowa, Covington Kentucky, New York, Grand Rapids Michigan, Bellevue Washington, San Antonio Texas, Vancouver Washington, Mesa Arizona, Scottsdale Arizona, Iowa, Tampa Florida, Ohio, Texas, Ann Arbor Michigan, Jacksonville Florida, Atlanta Georgia, Florida, Fort Worth Texas, Phoenix Arizona, Columbus Georgia, Layton Utah, Omaha Nebraska, Rochester New York, Sterling Heights Michigan, Madison Wisconsin 02/14/2025
- Program Manager, HCS (Remote) Arizona, Salt Lake City Utah, Dallas Texas, Atlanta Georgia, Idaho Falls Idaho, Sioux City Iowa, Louisville Kentucky, Racine Wisconsin, Caldwell Idaho, San Antonio Texas, Orlando Florida, Texas, St. Petersburg Florida, Layton Utah, Columbus Georgia, Houston Texas, Nampa Idaho, Jacksonville Florida, Miami Florida, Spokane Washington, Omaha Nebraska, Bellevue Washington, Scottsdale Arizona, Phoenix Arizona, Roswell New Mexico, Macon Georgia, Georgia, Meridian Idaho, Covington Kentucky, New Mexico, Detroit Michigan, Rochester New York, Buffalo New York, Provo Utah, Yonkers New York, Florida, Columbus Ohio, Washington, Sterling Heights Michigan, Grand Rapids Michigan, Iowa City Iowa, Lincoln Nebraska, Nebraska, Davenport Iowa, Chandler Arizona, Rio Rancho New Mexico, Kenosha Wisconsin, Milwaukee Wisconsin, New York, New York New York, Dayton Ohio, Vancouver Washington, Orem Utah, Owensboro Kentucky, Bellevue Nebraska, Wisconsin, Cedar Rapids Iowa, Santa Fe New Mexico, Savannah Georgia, Akron Ohio, Austin Texas, Fort Worth Texas, Seattle Washington, Augusta Georgia, Boise Idaho, Cincinnati Ohio, Warren Michigan, Kearney Nebraska, Las Cruces New Mexico, Tucson Arizona, Utah, Syracuse New York, Idaho, Tampa Florida, Bowling Green Kentucky, Grand Island Nebraska, Albuquerque New Mexico, Iowa, Madison Wisconsin, Des Moines Iowa, West Valley City Utah, Tacoma Washington, Cleveland Ohio, Lexington-Fayette Kentucky, Ann Arbor Michigan, Kentucky, Michigan, Mesa Arizona, Green Bay Wisconsin, Ohio 02/14/2025
- Family Field Nurse Practitioner (Los Angeles, CA) Los Angeles California 02/13/2025