Pharmacy Technician - Prior Auth Review (Remote PST Hours)
Molina Healthcare is hiring for a Pharmacy Technician who is BOTH State Licensed/Certified and Nationally certified. This role is 100% remote, and the shift times we are filling are as follows. Monday through Friday 7a-330pm PST, 8a-430pm PST, 9a-530pm PST, 10a-630p PST, 11a-730pm PST Rotating weekends This role will be reviewing incoming Prior Auth requests for Medicaid and Marketplace members through both the medical and pharmacy benefit. There will be coordination with pharmacists to make determinations on cases. Highly qualified candidates for this role will have the following experience- Positive "Can Do" attitude Specialty Pharmacy (any) and Retail Pharmacy (at least 3 years) experience are ideal Must be computer savvy- able to work within several computer systems at once, MS Note experience a plus Managed care experience High level of communication skills, both written and verbal Able to utilize resources to work independently Molina Pharmacy Services/Management staff work to ensure that Molina members 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 Molina Health Plan's pharmacy benefit programs in accordance with all federal and state laws. Jobs in this family include those involved in formulary management (such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and pharmacy costs management), clinical pharmacy services (such as, therapeutic drug monitoring, drug regimen review, patient education, and medical staff interaction), and oversight (establishing and measuring performance metrics regarding patient outcomes, medications safety and medication use policies). KNOWLEDGE/SKILLS/ABILITIES Performs initial receipt and review of non-formulary or prior authorization requests against plan approved criteria. Requests additional information from providers as needed to properly evaluate the request. Accurately enters on-line approvals or denials of requests. Authorized to make and carry out simple prior authorization requests within established policies and procedures. Participates in the development /administration of programs designed to enhance the utilization of targeted drugs and the identification of cost saving pharmacy practices. Identifies and reports departmental operational issues and resource needs to appropriate management. Assists Molina Member Services, pharmacies, and health plan providers in resolving member prescription claim, prior authorization, or pharmacy services access issues. Articulates Pharmacy Management policies and procedures to pharmacy/health plan providers, other Molina staff and others as needed. JOB QUALIFICATIONS Required Education: High School Diploma or GED equivalent Preferred Education: Associate's degree Required Experience: 2 years' experience as a Pharmacy Technician Preferred Experience: 3+ years Required License, Certification, Association: Active and unrestricted Pharmacy Technician Certification To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Key Words: Pharmacy Technician, Pharm Tech, Tech, National Certification, State License, Certification, Claims, Pharmacy Claims, Pharmacy, PBM, Customer Service, National Certified Pharmacy Technician (CPhT) certification, Medicaid, Medicare, Managed Care, MCO, Exchange, PBM, Pharmacy Benefit Management, Prior Auth Same Posting Description for Internal and External Candidates
About Us
Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Apply Job!