Specialist, Pharmacy Ops
Molina Healthcare Albany, New York; Everett, Washington; Utah; Florida; Idaho; Wisconsin; Texas; Georgia; Michigan; New Mexico; Kentucky; Iowa; Nebraska; New York; Washington; Ohio; Orem, Utah; Vancouver, Washington; Spokane, Washington; Cincinnati, Ohio; Savannah, Georgia; Madison, Wisconsin; Phoenix, Arizona; Chandler, Arizona; Rio Rancho, New Mexico; Covington, Kentucky; Lincoln, Nebraska; Grand Island, Nebraska; Provo, Utah; Nampa, Idaho; Houston, Texas; Des Moines, Iowa; Akron, Ohio; Bellevue, Washington; Tacoma, Washington; Syracuse, New York; Buffalo, New York; Augusta, Georgia; Caldwell, Idaho; Tucson, Arizona; Fort Worth, Texas; Dayton, Ohio; Cleveland, Ohio; West Valley City, Utah; Grand Rapids, Michigan; Sterling Heights, Michigan; Rochester, New York; Racine, Wisconsin; Milwaukee, Wisconsin; Boise, Idaho; Meridian, Idaho; Austin, Texas; Owensboro, Kentucky; Louisville, Kentucky; Omaha, Nebraska; Layton, Utah; Jacksonville, Florida; Orlando, Florida; Columbus, Ohio; Kenosha, Wisconsin; Idaho Falls, Idaho; Albuquerque, New Mexico; Las Cruces, New Mexico; Kearney, Nebraska; Iowa City, Iowa; Roswell, New Mexico; Ann Arbor, Michigan; Yonkers, New York; Columbus, Georgia; Mesa, Arizona; Dallas, Texas; Bowling Green, Kentucky; Bellevue, Nebraska; Sioux City, Iowa; Davenport, Iowa; Cedar Rapids, Iowa; Salt Lake City, Utah; Detroit, Michigan; Tampa, Florida; Miami, Florida; Macon, Georgia; Green Bay, Wisconsin; Scottsdale, Arizona; Warren, Michigan; St. Petersburg, Florida; Atlanta, Georgia; San Antonio, Texas; Santa Fe, New Mexico; Lexington-Fayette, Kentucky Job ID 2031249JOB DESCRIPTION
Job Summary
The Specialist, Pharmacy Operations is responsible for the oversight of delegated services, implementation of new products and services and maintenance of business. This role will be the primary contact for affiliated health plans, Pharmacy Benefit Managers and Corporate shared services with respect to pharmacy operations. This role is very dynamic, and the department is fast paced, requiring attention to detail, analysis and excellent communication.
KNOWLEDGE/SKILLS/ABILITIES
- Support Medicaid, and Marketplace lines of business with an emphasis on Marketplace
- Surveillance and Oversight of delegated functions:
- Analyze and interpret data to identify erroneous execution of the pharmacy benefit by the PBM
- Review the daily inventory of “outliers” and remediate as required
- Review protocols for accuracy and compliance. Includes: Claims, Network, Digital, etc.
- Support internal/external audits
- Monitoring state and federal landscape for new opportunities
- Collaborate with cross functional partners to implement new products and services, as well as support the maintenance of existing business
- Develop and maintain requirements, user stories, test scenarios and test cases
- Support testing execution and defect management
- Review and interpret member's eligibility, claim history, and pharmacy benefit information using the PBM claims software to provide information to both internal and external clients
- Serve as a PBM liaison and other internal teams for real-time support on pharmacy benefit interpretation or issues
- Identify and assist to remediate gaps and/or deficiencies in current processes, tools, reports and dashboards
- Develop and maintain job aids, policies and process documents
- Other responsibilities as required.
JOB QUALIFICATIONS
Required Education
High School Diploma
Required Experience
- Must have strong data analysis skills and attention to detail
- 3-5 years' experience with pharmacy benefit management
- Strong organizational, problem solving, communication, and interpersonal skills
- Excellent written and oral communication skills required
- Must be able to multitask and be results oriented
- 3-5 years' experience in a Microsoft Windows environment, including Excel and Access
Preferred Education
Bachelor's degree
Preferred Experience
- 3-5 years' experience in a managed care of PBM environment
- 2+ years of Managed Medicaid or Health Exchanges.
- 2+ years of operational Marketplace experience
Preferred License, Certification, Association
National Certified Pharmacy Technician (CPhT) certification, preferred
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 - $42.2 / 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: 04/11/2025ABOUT OUR LOCATION
View Map- Manager, Medical Economics (Marketplace) - REMOTE Albany New York, Everett Washington, Idaho, Iowa, Kentucky, Florida, Michigan, New York, Georgia, Texas, Wisconsin, Ohio, Washington, Nebraska, New Mexico, Utah, Spokane Washington, Tampa Florida, Racine Wisconsin, Milwaukee Wisconsin, Idaho Falls Idaho, Roswell New Mexico, Grand Rapids Michigan, Buffalo New York, Bellevue Nebraska, Grand Island Nebraska, Phoenix Arizona, Santa Fe New Mexico, Albuquerque New Mexico, Orem Utah, Warren Michigan, Orlando Florida, Louisville Kentucky, Cincinnati Ohio, Columbus Georgia, Atlanta Georgia, Madison Wisconsin, Austin Texas, Las Cruces New Mexico, West Valley City Utah, Layton Utah, Miami Florida, Meridian Idaho, New York New York, Omaha Nebraska, Boise Idaho, Mesa Arizona, Rio Rancho New Mexico, Ann Arbor Michigan, Yonkers New York, Owensboro Kentucky, Lexington-Fayette Kentucky, Kearney Nebraska, Davenport Iowa, Des Moines Iowa, Cleveland Ohio, Columbus Ohio, Savannah Georgia, Chandler Arizona, Scottsdale Arizona, San Antonio Texas, Dallas Texas, Fort Worth Texas, Salt Lake City Utah, Bellevue Washington, Seattle Washington, Vancouver Washington, Rochester New York, Covington Kentucky, Sioux City Iowa, Dayton Ohio, Kenosha Wisconsin, Nampa Idaho, Tacoma Washington, St. Petersburg Florida, Syracuse New York, Bowling Green Kentucky, Lincoln Nebraska, Cedar Rapids Iowa, Akron Ohio, Macon Georgia, Houston Texas, Detroit Michigan, Jacksonville Florida, Iowa City Iowa, Augusta Georgia, Green Bay Wisconsin, Caldwell Idaho, Tucson Arizona, Provo Utah, Sterling Heights Michigan, Long Beach California 04/14/2025
- Delegation Oversight Nurse Remote based in CA (Must have a CA License) Everett Washington, Albany New York, New York, Idaho, Utah, Texas, Nebraska, Iowa, Florida, Michigan, New Mexico, Georgia, Ohio, Kentucky, Wisconsin, Washington, Chandler Arizona, West Valley City Utah, Nampa Idaho, New York New York, Lincoln Nebraska, Houston Texas, Tacoma Washington, Dallas Texas, Santa Fe New Mexico, Idaho Falls Idaho, Kearney Nebraska, Cleveland Ohio, Sioux City Iowa, Augusta Georgia, Miami Florida, Cincinnati Ohio, Madison Wisconsin, Columbus Georgia, Kenosha Wisconsin, Tampa Florida, Syracuse New York, Green Bay Wisconsin, Macon Georgia, Buffalo New York, Fort Worth Texas, Orem Utah, Seattle Washington, Iowa City Iowa, Ann Arbor Michigan, Yonkers New York, Rochester New York, Savannah Georgia, Covington Kentucky, Akron Ohio, Columbus Ohio, Omaha Nebraska, Meridian Idaho, Racine Wisconsin, Boise Idaho, Layton Utah, Phoenix Arizona, Austin Texas, Louisville Kentucky, Sterling Heights Michigan, Salt Lake City Utah, Bellevue Washington, San Antonio Texas, St. Petersburg Florida, Lexington-Fayette Kentucky, Rio Rancho New Mexico, Albuquerque New Mexico, Roswell New Mexico, Provo Utah, Tucson Arizona, Milwaukee Wisconsin, Vancouver Washington, Detroit Michigan, Owensboro Kentucky, Orlando Florida, Warren Michigan, Atlanta Georgia, Grand Island Nebraska, Caldwell Idaho, Des Moines Iowa, Bellevue Nebraska, Spokane Washington, Las Cruces New Mexico, Mesa Arizona, Dayton Ohio, Bowling Green Kentucky, Jacksonville Florida, Scottsdale Arizona, Grand Rapids Michigan 04/24/2025
- Care Review Clinician, Inpatient Review (RN) Everett Washington, Albany New York, Iowa, Texas, Nebraska, Ohio, Michigan, Washington, Wisconsin, Georgia, Kentucky, Idaho, New Mexico, Florida, Utah, New York, Nampa Idaho, Dallas Texas, Albuquerque New Mexico, Bellevue Washington, Tampa Florida, Owensboro Kentucky, Bowling Green Kentucky, Milwaukee Wisconsin, Meridian Idaho, Mesa Arizona, Las Cruces New Mexico, Salt Lake City Utah, St. Petersburg Florida, Yonkers New York, Bellevue Nebraska, Des Moines Iowa, Augusta Georgia, Caldwell Idaho, Idaho Falls Idaho, Layton Utah, Ann Arbor Michigan, Warren Michigan, Tacoma Washington, Jacksonville Florida, Orlando Florida, Buffalo New York, Lexington-Fayette Kentucky, Cleveland Ohio, Savannah Georgia, Chandler Arizona, Santa Fe New Mexico, West Valley City Utah, Orem Utah, Dayton Ohio, Macon Georgia, Green Bay Wisconsin, Tucson Arizona, Grand Rapids Michigan, Sterling Heights Michigan, Seattle Washington, Miami Florida, Syracuse New York, New York New York, Covington Kentucky, Omaha Nebraska, Grand Island Nebraska, Akron Ohio, Columbus Ohio, Racine Wisconsin, Scottsdale Arizona, Fort Worth Texas, Vancouver Washington, Sioux City Iowa, Cedar Rapids Iowa, Columbus Georgia, Atlanta Georgia, Madison Wisconsin, Phoenix Arizona, Austin Texas, Rio Rancho New Mexico, Roswell New Mexico, Spokane Washington, Rochester New York, Lincoln Nebraska, Davenport Iowa, San Antonio Texas, Houston Texas, Provo Utah, Detroit Michigan, Louisville Kentucky, Kearney Nebraska, Iowa City Iowa, Cincinnati Ohio, Kenosha Wisconsin, Boise Idaho 04/09/2025
- Medical Director Specialty Medical Services & Medicaid Perf. Albany New York, Everett Washington, Seattle Washington, New York New York, Milwaukee Wisconsin, Detroit Michigan, Kearney Nebraska, Las Cruces New Mexico, Rio Rancho New Mexico, Dallas Texas, Idaho Falls Idaho, Cedar Rapids Iowa, Iowa City Iowa, Racine Wisconsin, Nampa Idaho, Provo Utah, Layton Utah, Sioux City Iowa, New Mexico, Wisconsin, Scottsdale Arizona, Miami Florida, Augusta Georgia, Macon Georgia, Florida, Bellevue Washington, Owensboro Kentucky, Bellevue Nebraska, Caldwell Idaho, Idaho, Iowa, Nebraska, New York, Jacksonville Florida, Atlanta Georgia, Columbus Georgia, Vancouver Washington, Covington Kentucky, Sterling Heights Michigan, Rochester New York, Yonkers New York, Dayton Ohio, Austin Texas, Boise Idaho, Cincinnati Ohio, Michigan, Spokane Washington, Tacoma Washington, Davenport Iowa, Ohio, Washington, Tampa Florida, Orlando Florida, Madison Wisconsin, Grand Rapids Michigan, Omaha Nebraska, Lincoln Nebraska, Grand Island Nebraska, Salt Lake City Utah, Savannah Georgia, Syracuse New York, Utah, St. Petersburg Florida, Green Bay Wisconsin, Louisville Kentucky, Santa Fe New Mexico, Fort Worth Texas, Des Moines Iowa, Chandler Arizona, Bowling Green Kentucky, Warren Michigan, Ann Arbor Michigan, Albuquerque New Mexico, Roswell New Mexico, Buffalo New York, San Antonio Texas, Meridian Idaho, Cleveland Ohio, Akron Ohio, Orem Utah, Kentucky, Mesa Arizona, Kenosha Wisconsin, Lexington-Fayette Kentucky, Houston Texas, West Valley City Utah, Columbus Ohio, Georgia, Texas, Phoenix Arizona, Tucson Arizona 04/07/2025