Representative, Pharmacy

JOB DESCRIPTION Job SummaryProvides 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. Essential Job Duties u2022 Handles and records inbound/outbound pharmacy calls from members, providers and pharmacies in accordance with departmental policies, state regulations, National Committee of Quality Assurance (NCQA) guidelines, and Centers for Medicare and Medicaid Services (CMS) standards. u2022 Provides coordination and processing of pharmacy prior authorization requests and/or appeals. u2022 Explains point-of-sale claims adjudication, state, NCQA and CMS policies/guidelines, and any other necessary information to providers, members and pharmacies. u2022 Assists with clerical tasks and other day-to-day pharmacy call center operations as delegated. u2022 Effectively communicates plan benefit information, including but not limited to: formulary information, copay amounts, pharmacy location services and prior authorization outcomes. u2022 Assists members and providers with initiating verbal and written coverage determinations and appeals. u2022 Records calls accurately within the pharmacy call tracking system. u2022 Maintains established pharmacy call quality and quantity standards. u2022 Interacts with appropriate primary care providers to ensure member registry is current and accurate. u2022 Supports pharmacists with completion of comprehensive medication reviews (CMRs)through pre-work up to case preparation. u2022 Proactively identifies ways to improve pharmacy call center member relations. Required Qualifications u2022 At least 1 year related experience, including call center or customer service experience, or equivalent combination of relevant education and experience. u2022 Excellent customer service skills. u2022 Ability to work independently when assigned special projects, such as pill box requests, case management referrals, over the counter (OTC) requests, etc. u2022 Ability to multi-task applications while speaking with members. u2022 Ability to multi-task applications while speaking with members. u2022 Ability to develop and maintain positive and effective work relationships with coworkers, clients, members, providers, regulatory agencies, and vendors. u2022 Ability to meet established deadlines. u2022 Ability to function independently and manage multiple projects. u2022 Excellent verbal and written communication skills, including excellent phone etiquette. u2022 Microsoft Office suite (including Excel), and applicable software program(s) proficiency. Preferred Qualifications u2022 Certified Pharmacy Technician (CPhT) and/or state pharmacy technician license (state specific if state required). If licensed, license must be active and unrestricted in state of practice. u2022 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 Pay Range: $21.16 - $28.82 / HOURLY Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Created: 2025-10-20