Job Description
JOB DESCRIPTION Job Summary
Leads and manages team of pharmacy operations staff and Pharmacy Benefit Manager(PBM) activities. Responsible for oversight of delegated services, implementation of new products and services, and maintenance of business. Contributes to overarching pharmacy strategy for optimization of medication related health care outcomes, and quality cost-effective member care.
Essential Job Duties
• Hires, trains, develops and manages team responsible for internal business projects and programs involving department or cross-functional teams of subject matter experts, and delivering products through the design process to completion.
• Supports Medicaid and Marketplace lines of business.
• Provides surveillance and oversight of delegated functions.
• Analyzes and interprets data to identify erroneous execution of the pharmacy benefit by the Pharmacy Benefit Manager (PBM).
• Reviews the daily inventory of "outliers" and remediates as required.
• Reviews protocols for accuracy and compliance, including: claims, contracts, overrides, network, digital, etc.
• Supports internal/external pharmacy audits.
• Monitors state and federal landscape for new opportunities.
• Collaborates with cross-functional partners to implement new products and services and supports maintenance of existing business.
• Develops and maintains requirements, user stories, test scenarios and test cases.
• Supports testing execution and defect management.
• Reviews and interprets member eligibility, claim history, and pharmacy benefit information using the PBM claims software to provide information to both internal and external clients.
• Serves as PBM liaison for real-time support on pharmacy benefit interpretation or issues.
• Identifies and assists to remediate gaps and/or deficiencies in current pharmacy processes, tools, reports, and dashboards.
• Develops and maintains pharmacy job aids, policies, and process documents.
• Develops team members acumen in pharmacy services.
Required Qualifications
• At least 7 years of pharmacy experience, and at least 5 years of experience in Pharmacy Benefit Manager(PBM), and 4 years of experience in managed care, or equivalent combination of relevant education and experience.
• At least 1 year of health care management/leadership experience.
• Strong data analysis skills and attention to detail.
• Strong organizational and problem-solving skills.
• Knowledge of processes and systems, and ability develop and deliver necessary training to departmental staff and internal customers.
• Ability to develop and maintain positive and effective work relationships with coworkers, clients, members, providers, regulatory agencies and vendors.
• Ability to meet established deadlines.
• Ability to function independently and manage multiple projects.
• Excellent verbal and written communication skills.
• Microsoft Office suite (including Excel), and applicable software program(s) proficiency.
Preferred Qualifications
• 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.
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package.
