Supervisor, Medicare Pharmacy Operations/call Center

Job Summary

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.

Job Duties

• Hires, trains and manages 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 and 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.
• Interviews with potential technician and service representative job applicants and provides hiring recommendations to Manager or Director.
• Provides coaching for the technicians and representatives and helps identify and provide for training needs, in collaboration with pharmacy leadership.
• Collaborates with and keeps pharmacy leadership apprised of operational issues, including staffing resources, program and system needs.
• Assists with development of and maintains policies and procedures as needed.
• Participates in the development of programs designed to enhance preferential or required targeted drugs or supplies.

Job Qualifications

Required Qualifications

• At least 4 years of experience in pharmacy, managed care, Pharmacy Benefit Management (PBM) or health care, or equivalent combination of relevant education and experience.
• Knowledge of prescription drug products, dosage forms and usage.
• Proficiency in Microsoft Office programs (Word, Excel, MS Teams, and Outlook).
• Strong written and verbal communication skills.
• Excellent customer service skills.

Preferred Qualifications

• Supervisory/Leadership experience.
• Pharmacy Tech 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.
• Health care delivery and pharmacy prior authorization experience
• Knowledge of or experience with decision analysis and data analysis tools, such as SQL, Microsoft Access and Excel.
• Call Center experience.

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.

Pay Range: $55,706.51 - $96,558 / ANNUAL Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.