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Role Description

Leads and supervises team of pharmacy call center 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.

• Hires, trains, develops, and supervises a team of pharmacy technicians, pharmacy service representatives, and/or pharmacy internal monitors who support processes involved with the review of non-formulary drugs or other drugs requiring prior authorization.
• Supervises pharmacy daily unit operations to ensure prompt and appropriate processing of requests for non-formulary or prior authorized required drugs.
• 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 compliance department 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 Technician and/or Representative duties as needed.
• Facilitates interviews pharmacy technician/service representative job applicants, and provides hiring recommendations to leadership.
• Provides coaching for pharmacy technicians and 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 as needed.
• Participates in the development of programs designed to enhance preferential or required targeted drugs or supplies.

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 projects.
• Working knowledge of medical/pharmacy terminology, state and National Committee for Quality Assurance (NCQA) guidelines.
• Excellent verbal and written communication skills.
• Microsoft Office suite, and applicable software program(s) proficiency.

Requirements

• 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.
• Pharmacy experience.

Benefits

Molina Healthcare offers a competitive benefits and compensation package.

Company Description

Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.