Pharmacy Representative
4 days ago
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.
- 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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Pharmacy Representative
2 days ago
Long Beach, California, United States Molina Healthcare Full timeJob Overview 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 pharmacy benefit programs are operating effectively and efficiently. Responsibilities * Handle and record inbound pharmacy calls from members, providers, and pharmacies to...
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Long Beach, California, United States Molina Healthcare Full timeJob Title: Customer Service Representative, Medicare PharmacyJob 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...
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Pharmacy Technician, Intermediate
4 weeks ago
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Pharmacy Technician, Intermediate
4 weeks ago
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Pharmacy Technician, Intermediate
3 weeks ago
Long Beach, California, United States Blue Shield of CA Full timeAbout the RoleThe UMRx Prior Authorization team is responsible for ensuring accurate and timely review of IV and injectable medications under the medical benefit, using Blue Shield of California Pharmacy and Therapeutics (P&T) Committee medication policies.Your ResponsibilitiesUtilize medication policy and operational principles to make authorization...
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Community Resource Center Representative
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Community Resource Center Representative
3 weeks ago
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Community Resource Center Representative
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Community Resource Center Representative
3 days ago
Long Beach, California, United States Blue Shield of California Full timeAbout the RoleThis position is located at our Wilmington Community Resource Center and requires the employee to work 5 days a week in the Wilmington Community Resource Center.Job SummaryThe Community Resource Center (CRC) team is responsible for managing the Blue Shield Promise Health Plan Information Resource Center (IRC) and jointly operating CRCs...
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Customer Service Representative
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Pharmacist Manager
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Nurse Practitioner
2 days ago
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CVS Health Retail Store Associate
5 hours ago
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TeleSales and Retention Representative
2 days ago
Huntington Beach, California, United States VERDA HEALTHCARE, INC. Full timeJob OverviewVerda Healthcare, Inc. is seeking a highly motivated and customer-focused TeleSales and Retention Representative to join our team. As a key member of our sales team, you will be responsible for selling Medicare insurance products to customers over the phone, providing exceptional customer service, and meeting sales targets.Key...
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Huntington Beach, California, United States VERDA HEALTHCARE, INC. Full timeJob Title:TeleSales and Retention Representative BilingualJob Summary:Verda Healthcare, Inc. is seeking a highly motivated and customer-focused TeleSales and Retention Representative Bilingual to join our team. As a key member of our sales team, you will be responsible for selling Medicare insurance products to customers over the phone, providing exceptional...
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TeleSales and Retention Representative
1 month ago
Huntington Beach, California, United States VERDA HEALTHCARE, INC. Full timeJob SummaryWe are seeking a highly skilled TeleSales and Retention Representative to join our team at Verda Healthcare, Inc. As a key member of our sales team, you will be responsible for selling Medicare insurance products to customers over the phone, providing exceptional customer service, and meeting sales targets.Key ResponsibilitiesProvide quality...
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Member Experience Representative
3 weeks ago
Huntington Beach, California, United States VERDA HEALTHCARE, INC. Full timeJob DescriptionVerda Healthcare, Inc. is seeking a highly skilled Member Experience Representative - Bilingual (Vietnamese) to join our team. As a key member of our customer service team, you will be responsible for providing exceptional service to our Medicare members, addressing their inquiries, questions, and concerns in a timely and professional...
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TeleSales and Retention Representative
2 weeks ago
Huntington Beach, California, United States VERDA HEALTHCARE, INC. Full timeJob SummaryWe are seeking a highly skilled and experienced TeleSales and Retention Representative to join our team at Verda Healthcare, Inc. As a key member of our sales team, you will be responsible for selling Medicare insurance products to customers over the phone, providing exceptional customer service, and meeting sales targets.Key...
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TeleSales and Retention Representative
2 weeks ago
Huntington Beach, California, United States VERDA HEALTHCARE, INC. Full timeJob SummaryWe are seeking a highly skilled and experienced TeleSales and Retention Representative to join our team at Verda Healthcare, Inc. As a key member of our sales and customer service team, you will be responsible for selling and promoting our Medicare Advantage Prescription Drug (MAPD) plan to prospective members.Key ResponsibilitiesProvide...
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CVS Health Retail Store Associate
3 days ago
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