Supervisor, Medicare Pharmacy Operations/call Center

Job Summary

Leads and supervises a team of pharmacy call center and operations staff to ensure members have access to medically necessary prescription drugs. Contributes to the 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 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 for 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.

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.