What are the responsibilities and job description for the Specialist, Pharmacy Ops position at Molina Healthcare Group?
Job Description
JOB DESCRIPTION
Job Summary
The Specialist, Pharmacy Operations is responsible for the oversight of delegated services, implementation of new products and services and maintenance of business. This role will be the primary contact for affiliated health plans, Pharmacy Benefit Managers and Corporate shared services with respect to pharmacy operations. This role is very dynamic, and the department is fast paced, requiring attention to detail, analysis and excellent communication.
KNOWLEDGE/SKILLS/ABILITIES
- Support Medicaid, and Marketplace lines of business with an emphasis on Marketplace
- Surveillance and Oversight of delegated functions:
- Analyze and interpret data to identify erroneous execution of the pharmacy benefit by the PBM
- Review the daily inventory of “outliers” and remediate as required
- Review protocols for accuracy and compliance. Includes: Claims, Network, Digital, etc.
- Support internal/external audits
- Monitoring state and federal landscape for new opportunities
- Collaborate with cross functional partners to implement new products and services, as well as support the maintenance of existing business
- Develop and maintain requirements, user stories, test scenarios and test cases
- Support testing execution and defect management
- Review and interpret member's eligibility, claim history, and pharmacy benefit information using the PBM claims software to provide information to both internal and external clients
- Serve as a PBM liaison and other internal teams for real-time support on pharmacy benefit interpretation or issues
- Identify and assist to remediate gaps and/or deficiencies in current processes, tools, reports and dashboards
- Develop and maintain job aids, policies and process documents
- Other responsibilities as required.
JOB QUALIFICATIONS
Required Education
High School Diploma
Required Experience
- Must have strong data analysis skills and attention to detail
- 3-5 years' experience with pharmacy benefit management
- Strong organizational, problem solving, communication, and interpersonal skills
- Excellent written and oral communication skills required
- Must be able to multitask and be results oriented
- 3-5 years' experience in a Microsoft Windows environment, including Excel and Access
Preferred Education
Bachelor's degree
Preferred Experience
- 3-5 years' experience in a managed care of PBM environment
- 2 years of Managed Medicaid or Health Exchanges.
- 2 years of operational Marketplace experience
Preferred License, Certification, Association
National Certified Pharmacy Technician (CPhT) certification, preferred
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.
Job Info
Job Identification: 2031249
Job Category: Pharmacy
Posting Date: 2025-04-11T18:10:41 00:00
Job Schedule: Full time
