Pharmacy Representative

4 days ago


Long Beach, California, United States Molina Healthcare Full time
Job Title: Pharmacy Representative

Molina Healthcare is seeking a highly skilled Pharmacy Representative to join our team. As a Pharmacy Representative, you will play a critical role in ensuring that our members have access to necessary prescription medications while maintaining a cost-effective and safe approach.

Key Responsibilities:
  • Handle inbound pharmacy calls from members, providers, and pharmacies to meet departmental, state regulations, NCQA guidelines, and CMS standards.
  • Process pharmacy prior authorization requests and/or appeals, providing coordination and support as needed.
  • Explain Point of Sale claims adjudication, state, NCQA, and CMS policy/guidelines to providers, members, and pharmacies.
  • Assist with clerical services/tasks and other day-to-day operations as delegated.
  • Effectively communicate plan benefit information, including formulary information, copay amounts, pharmacy location services, and prior authorization outcomes.
  • Assist members and providers with initiating oral and written coverage determinations and appeals.
  • Record calls accurately in the call tracking system.
  • Maintain specific quality and quantity standards.
Requirements:
  • High School Diploma or GED equivalent.
  • 1-3 years of call center or customer service experience.
  • Preferred: Associate degree, 3-5 years of healthcare industry experience, and national pharmacy technician certification.

Molina Healthcare offers a competitive benefits and compensation package. We are an Equal Opportunity Employer (EOE) M/F/D/V.



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