Customer Service Representative, Medicare Pharmacy
Molina Healthcare Nampa, Idaho; Cincinnati, Ohio; Cleveland, Ohio; New York; Utah; Everett, Washington; Roswell, New Mexico; Macon, Georgia; Orlando, Florida; Yonkers, New York; Vancouver, Washington; Green Bay, Wisconsin; Kenosha, Wisconsin; Louisville, Kentucky; Layton, Utah; Florida; Ohio; Sterling Heights, Michigan; Chandler, Arizona; Mesa, Arizona; Fort Worth, Texas; Austin, Texas; Bellevue, Washington; Bellevue, Nebraska; Cedar Rapids, Iowa; Scottsdale, Arizona; Davenport, Iowa; Jacksonville, Florida; Syracuse, New York; Iowa; Columbus, Ohio; Caldwell, Idaho; Kearney, Nebraska; Miami, Florida; Orem, Utah; Omaha, Nebraska; Albuquerque, New Mexico; New Mexico; Wisconsin; Des Moines, Iowa; Tucson, Arizona; Grand Island, Nebraska; Rochester, New York; Lincoln, Nebraska; San Antonio, Texas; Spokane, Washington; Rio Rancho, New Mexico; Racine, Wisconsin; Akron, Ohio; Grand Rapids, Michigan; Meridian, Idaho; Michigan; Idaho Falls, Idaho; Phoenix, Arizona; Milwaukee, Wisconsin; Ann Arbor, Michigan; Las Cruces, New Mexico; Georgia; Atlanta, Georgia; West Valley City, Utah; Savannah, Georgia; Sioux City, Iowa; Provo, Utah; Tacoma, Washington; St. Petersburg, Florida; Iowa City, Iowa; Dayton, Ohio; Santa Fe, New Mexico; Buffalo, New York; Texas; Washington; Lexington-Fayette, Kentucky; Dallas, Texas; Nebraska; Albany, New York; Boise, Idaho; Bowling Green, Kentucky; Houston, Texas; Covington, Kentucky; Tampa, Florida; Madison, Wisconsin; Salt Lake City, Utah; Kentucky; Warren, Michigan; Idaho; Owensboro, Kentucky; Columbus, Georgia; Augusta, Georgia; Detroit, Michigan Job ID 2032654JOB DESCRIPTION
Job Summary
Molina Pharmacy Services/Management staff work to ensure that Molina members, providers, and pharmacies 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
- Handles and records inbound pharmacy calls from members, providers, and pharmacies to meet departmental, State regulations, NCQA guidelines, and CMS standards.
- Provides coordination and processing of pharmacy prior authorization requests and/or appeals.
- Explains Point of Sale claims adjudication, state, NCQA, and CMS policy/guidelines, and any other necessary information to providers, members, and pharmacies.
- Assists with clerical services/tasks and other day-to-day operations as delegated.
- Effectively communicates plan benefit information, including but not limited to, formulary information, copay amounts, pharmacy location services and prior authorization outcomes.
- Assists member and providers with initiating oral and written coverage determinations and appeals.
- Records calls accurately in call tracking system.
- Maintains specific quality and quantity standards.
JOB QUALIFICATIONS
Required Education
High School Diploma or GED equivalent
Required Experience
1-3 years of call center or customer service experience
Preferred Education
Associate degree
Preferred Experience
- 3-5 years; healthcare industry experience preferred
- National 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.
Pay Range: $21.16 - $28.82 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
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.
Job Type: Full Time Posting Date: 07/21/2025ABOUT OUR LOCATION
View Map- Care Review Processor Boise Idaho, West Valley City Utah, Savannah Georgia, Davenport Iowa, Grand Island Nebraska, Akron Ohio, Santa Fe New Mexico, Grand Rapids Michigan, Meridian Idaho, Kearney Nebraska, Bellevue Washington, Caldwell Idaho, Owensboro Kentucky, Nampa Idaho, Dayton Ohio, Jacksonville Florida, Madison Wisconsin, Buffalo New York, Cincinnati Ohio, Des Moines Iowa, Columbus Georgia, Columbus Ohio, Augusta Georgia, Lincoln Nebraska, Tacoma Washington, Macon Georgia, Layton Utah, Milwaukee Wisconsin, Tampa Florida, Cedar Rapids Iowa, Washington, Ann Arbor Michigan, Racine Wisconsin, Cleveland Ohio, Vancouver Washington, Houston Texas, Sterling Heights Michigan, Chandler Arizona, Orlando Florida, Florida, Bellevue Nebraska, New York, Green Bay Wisconsin, Orem Utah, Provo Utah, Salt Lake City Utah, Lexington-Fayette Kentucky, Yonkers New York, Georgia, Idaho, Everett Washington, Austin Texas, Texas, Michigan, Omaha Nebraska, Iowa City Iowa, Bowling Green Kentucky, San Antonio Texas, Scottsdale Arizona, Syracuse New York, Mesa Arizona, Louisville Kentucky, Tucson Arizona, Roswell New Mexico, Rochester New York, Atlanta Georgia, Wisconsin, Utah, Iowa, Covington Kentucky, St. Petersburg Florida, Phoenix Arizona, Idaho Falls Idaho, Kenosha Wisconsin, Rio Rancho New Mexico, Miami Florida, Detroit Michigan, Nebraska, New Mexico, Ohio, Sioux City Iowa, Albuquerque New Mexico, Las Cruces New Mexico, Dallas Texas, Warren Michigan, Fort Worth Texas, Kentucky, Spokane Washington, Albany New York 07/21/2025
- Customer Service Representative, Medicare Pharmacy Nampa Idaho, Cincinnati Ohio, Cleveland Ohio, New York, Utah, Everett Washington, Roswell New Mexico, Macon Georgia, Orlando Florida, Yonkers New York, Vancouver Washington, Green Bay Wisconsin, Kenosha Wisconsin, Louisville Kentucky, Layton Utah, Florida, Ohio, Sterling Heights Michigan, Chandler Arizona, Mesa Arizona, Fort Worth Texas, Austin Texas, Bellevue Washington, Bellevue Nebraska, Cedar Rapids Iowa, Scottsdale Arizona, Davenport Iowa, Jacksonville Florida, Syracuse New York, Iowa, Columbus Ohio, Caldwell Idaho, Kearney Nebraska, Miami Florida, Orem Utah, Omaha Nebraska, Albuquerque New Mexico, New Mexico, Wisconsin, Des Moines Iowa, Tucson Arizona, Grand Island Nebraska, Rochester New York, Lincoln Nebraska, San Antonio Texas, Spokane Washington, Rio Rancho New Mexico, Racine Wisconsin, Akron Ohio, Grand Rapids Michigan, Meridian Idaho, Michigan, Idaho Falls Idaho, Phoenix Arizona, Milwaukee Wisconsin, Ann Arbor Michigan, Las Cruces New Mexico, Georgia, Atlanta Georgia, West Valley City Utah, Savannah Georgia, Sioux City Iowa, Provo Utah, Tacoma Washington, St. Petersburg Florida, Iowa City Iowa, Dayton Ohio, Santa Fe New Mexico, Buffalo New York, Texas, Washington, Lexington-Fayette Kentucky, Dallas Texas, Nebraska, Albany New York, Boise Idaho, Bowling Green Kentucky, Houston Texas, Covington Kentucky, Tampa Florida, Madison Wisconsin, Salt Lake City Utah, Kentucky, Warren Michigan, Idaho, Owensboro Kentucky, Columbus Georgia, Augusta Georgia, Detroit Michigan 07/21/2025
- Pharmacy Technician Texas, Milwaukee Wisconsin, Chandler Arizona, Rio Rancho New Mexico, Bellevue Washington, Louisville Kentucky, Iowa City Iowa, Scottsdale Arizona, Miami Florida, Kearney Nebraska, Dayton Ohio, Albuquerque New Mexico, Orem Utah, Georgia, Lexington-Fayette Kentucky, Vancouver Washington, Bellevue Nebraska, Green Bay Wisconsin, West Valley City Utah, Omaha Nebraska, Layton Utah, Yonkers New York, Atlanta Georgia, Provo Utah, Cincinnati Ohio, Ohio, Columbus Georgia, Everett Washington, Nampa Idaho, New Mexico, Arizona, Davenport Iowa, Columbus Ohio, Savannah Georgia, Sioux City Iowa, Bowling Green Kentucky, Florida, Cleveland Ohio, Grand Island Nebraska, Akron Ohio, Boise Idaho, Phoenix Arizona, Lincoln Nebraska, Racine Wisconsin, Madison Wisconsin, Macon Georgia, Cedar Rapids Iowa, Idaho, Tampa Florida, San Antonio Texas, Utah, Fort Worth Texas, Wisconsin, Spokane Washington, St. Petersburg Florida, Iowa, Des Moines Iowa, Roswell New Mexico, Covington Kentucky, Washington, Buffalo New York, Rochester New York, Dallas Texas, Albany New York, Augusta Georgia, Orlando Florida, Meridian Idaho, Caldwell Idaho, New York, Syracuse New York, Salt Lake City Utah, Austin Texas, Tacoma Washington, Detroit Michigan, Warren Michigan, Ann Arbor Michigan, Sterling Heights Michigan, Grand Rapids Michigan, Houston Texas, Jacksonville Florida, Kentucky, Owensboro Kentucky, Kenosha Wisconsin, Idaho Falls Idaho, Nebraska, Santa Fe New Mexico, Tucson Arizona, Mesa Arizona, Las Cruces New Mexico 06/24/2025
- Senior Finance Analyst (FP&A / G&A) - REMOTE Iowa, Miami Florida, Idaho Falls Idaho, Lexington-Fayette Kentucky, Dallas Texas, Bellevue Washington, Michigan, Dayton Ohio, Phoenix Arizona, Kentucky, Roswell New Mexico, Meridian Idaho, Warren Michigan, Vancouver Washington, Spokane Washington, Bellevue Nebraska, Des Moines Iowa, Columbus Georgia, Green Bay Wisconsin, Utah, Akron Ohio, Bowling Green Kentucky, Nebraska, Tucson Arizona, Kearney Nebraska, Cedar Rapids Iowa, Caldwell Idaho, Boise Idaho, Tacoma Washington, St. Petersburg Florida, Georgia, Kenosha Wisconsin, Cincinnati Ohio, Rio Rancho New Mexico, Columbus Ohio, Owensboro Kentucky, Texas, San Antonio Texas, Albuquerque New Mexico, Atlanta Georgia, Detroit Michigan, Salt Lake City Utah, Scottsdale Arizona, West Valley City Utah, Nampa Idaho, Davenport Iowa, Washington, Iowa City Iowa, Idaho, Santa Fe New Mexico, Ohio, Las Cruces New Mexico, Yonkers New York, Sterling Heights Michigan, Orlando Florida, Provo Utah, Tampa Florida, Mesa Arizona, Augusta Georgia, Albany New York, Everett Washington, Austin Texas, Savannah Georgia, Covington Kentucky, Jacksonville Florida, Wisconsin, Syracuse New York, Buffalo New York, Grand Island Nebraska, Macon Georgia, Milwaukee Wisconsin, Sioux City Iowa, Omaha Nebraska, Ann Arbor Michigan, Layton Utah, Orem Utah, New York, Madison Wisconsin, Grand Rapids Michigan, Rochester New York, Chandler Arizona, Houston Texas, Louisville Kentucky, Fort Worth Texas, Lincoln Nebraska, New Mexico, Racine Wisconsin, Florida, Cleveland Ohio 07/01/2025
No recently viewed jobs.
View All JobsNo saved jobs.
View All Jobs