नोकरीचे वर्णन

Overview

Molina Healthcare is seeking multiple Pharmacy Customer Service Representatives for a remote call center team that supports pharmacy prior authorization and utilization management activity. The role focuses on helping Medicaid and Marketplace members, along with providers and pharmacies, with pharmacy-related service needs. Applicants in later U.S. time zones are especially encouraged.

This is a pharmacy contact-center position centered on resolving issues during the first interaction and delivering a strong member experience.

Work schedule

The standard schedule is Monday through Friday, from 10:00 AM to 6:30 PM PST, though hours may change based on business requirements.

Key responsibilities

Answer and place pharmacy-related calls for members, providers, and pharmacies while supporting overall medication access and quality outcomes.
Document inbound and outbound calls in line with company procedures, state rules, NCQA expectations, and CMS requirements.
Process prior authorization requests and appeal-related work.
Explain pharmacy claim decisions at the point of sale and clarify relevant policies, including formulary details, copay information, pharmacy location support, and prior authorization results.
Handle clerical tasks and other routine pharmacy call center duties as assigned.
Help members and providers start verbal or written coverage determination and appeal requests.
Enter call details accurately into the pharmacy tracking system.
Work to meet set standards for call quality and productivity.
Coordinate with primary care providers to keep member registry information accurate and up to date.
Support pharmacists with comprehensive medication review preparation and related pre-work.
Look for opportunities to improve the member experience within the pharmacy call center.

Required qualifications

At least 1 year of relevant experience, which may include call center or customer service work, or a comparable mix of education and experience.
Strong customer service capability.
Ability to work on independent assignments such as pill box requests, case management referrals, and OTC requests.
Comfort juggling multiple applications while speaking with members.
Ability to build and maintain productive working relationships with coworkers, clients, members, providers, regulatory bodies, and vendors.
Ability to meet deadlines and manage several priorities independently.
Clear verbal and written communication skills, including professional phone etiquette.
Working knowledge of Microsoft Office, including Excel, and other relevant software tools.

Preferred qualifications

Certified Pharmacy Technician (CPhT) certification and/or a state pharmacy technician license, where required by the state. Any license must be active and unrestricted in the state of practice.
Prior experience in the healthcare industry.

Compensation and additional information

The posted pay range is $11.09 to $24.02 per hour. Actual pay may differ depending on geographic location, prior work experience, education, and skill level.

Molina Healthcare states that it offers competitive benefits and a compensation package. The company is an Equal Opportunity Employer (EOE) M/F/D/V.

Current Molina employees who want to apply are instructed to use the internal job board.

Pharmacy Customer Service Representative