Pharmacy Service Coordinator

6 days ago


Bowling Green, Kentucky, United States Molina Healthcare Full time

Company Overview: Molina Healthcare is a leading healthcare provider dedicated to delivering quality care to its members. We are seeking a highly skilled Pharmacy Service Coordinator to join our team.

Job Summary

The Pharmacy Service Coordinator will be responsible for ensuring that Molina members, providers, and pharmacies have access to all medically necessary prescription drugs in a cost-effective, safe manner. This role will involve creating, operating, and monitoring Molina Health Plan's pharmacy benefit programs in accordance with federal and state laws.

Key Responsibilities:
  • Handles and records inbound pharmacy calls from members, providers, and pharmacies to meet departmental, State regulations, NCQA guidelines, and CMS standards.
  • Provides coordination and processing of pharmacy prior authorization requests and/or appeals.
  • Explains Point of Sale claims adjudication, state, NCQA, and CMS policy/guidelines, and any other necessary information to providers, members, and pharmacies.
  • Assists with clerical services/tasks and other day-to-day operations as delegated.
  • Maintains specific quality and quantity standards.

This role requires strong communication and organizational skills, as well as the ability to work effectively in a fast-paced environment.

Qualifications:

To be successful in this role, you will need:

  • A High School Diploma or GED equivalent.
  • 1-3 years of call center or customer service experience.
  • PREFERRED EDUCATION: Associate degree.
  • PREFERRED EXPERIENCE: 3-5 years; healthcare industry experience preferred.
  • National pharmacy technician certification.

We offer a competitive benefits and compensation package, including a salary range of $20.29 - $28.82 per hour.



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