"Alerted.org

JOB DESCRIPTION

Job Summary

Leads and supervises a team of pharmacy call center representatives and operations staff responsible to ensure that members have access to medically necessary prescription drugs. Contributes to overarching pharmacy strategy for optimization of medication related health care outcomes, and quality cost-effective member care.

Essential Job Duties

• Hires, trains, develops, and supervises a team of pharmacy service representatives supporting processes involved with Medicare Stars and Pharmacy quality operations.

• Ensures that average phone call handle time, average speed to answer, and average hold time are compliant with Centers for Medicare and Medicaid Services (CMS) regulations.

• Ensures that adequate staffing coverage is present at all times of operation.

• Assists pharmacy leadership with monitoring and oversight of Molina's contracted Pharmacy Benefit Manager (PBM) for pharmacy contractually delegated functions.

• Responsible for key performance indicators (KPI) reporting to department leadership on a monthly basis.

• Participates, researches, and validates materials for both internal and external program audits.

• Acts as liaison to internal and external customers to ensure prompt resolution of identified issues.

• Assists pharmacy leadership in the collection and tabulation of data for reporting purposes and maintains files of confidential information submitted for review.

• Assures that activities and processes are compliant with CMS, National Committee of Quality Assurance (NCQA) guidelines, and Molina policies and procedures.

• Participates in the daily workload of the department, performing Representative duties as needed.

• Facilitates interviews with pharmacy service representative job applicants, and provides hiring recommendations to leadership.

• Provides coaching for pharmacy representatives, and helps identify and provide for training needs in collaboration with pharmacy leadership.

• Communicates effectively with practitioners and pharmacists.

• Collaborates with and keeps pharmacy leadership apprised of operational issues, including staffing resources, program and system needs.

• Assists with development of and maintenance of pharmacy policies and procedures

• Participates in the development of programs designed to enhance preferential or required targeted drugs or supplies.

Required Qualifications

• At least 5 years of experience in health care, preferably within a health-related call center environment, or equivalent combination of relevant education and experience.

• Knowledge of prescription drug products, dosage forms and usage.

• Experience designing, implementing, monitoring, and evaluating metrics that measure call center agent productivity.

• Working knowledge of medical/pharmacy terminology

• Excellent verbal and written communication skills.

• Microsoft Office suite, and applicable software program(s) proficiency.

Preferred Qualifications

• Supervisory/leadership experience.

• 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.

• Call center experience.

• Managed care 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: $55,706.51 - $80,464.96 / ANNUAL

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.