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Specialist, Pharmacy Operations (Medicaid/ PBM experience)
Molina Healthcare Job ID 2036203Essential Job Duties
• Supports designated lines of business 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 daily inventory of “outliers” and remediates as required.
• Reviews protocols for accuracy and compliance including: claims, network, digital, etc.
• Supports internal/external pharmacy audits.
• Monitors state and federal landscape for new delegated pharmacy opportunities.
• Collaborates with cross-functional partners to implement new pharmacy products and services and support 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 and internal liaison for real-time support on pharmacy benefit interpretation or issues.
• Identifies and assists to remediate gaps and/or deficiencies in current processes, tools, reports and dashboards.
• Develops and maintains pharmacy related job aids, policies and process documents.
Required Qualifications
• At least 1 year experience in a pharmacy or Pharmacy Benefit Manager (PBM) environment, or equivalent combination of relevant education and experience.
• Strong data analysis skills and attention to detail.
• Strong organizational and problem-solving skills. .
• Ability to multitask and demonstrate results oriented work.
• Excellent verbal and written communication skills
• Microsoft Office suite (including Excel), and applicable software program(s) proficiency.
Preferred Qualifications• Certified Pharmacy Technician (CPhT).
• Experience in a managed care Pharmacy Benefit Manager (PBM) environment.
• Managed care Medicaid/Marketplace/Medicare experience.
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. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Pay Range: $16.23 - $35.17 / 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 03/02/2026Job Alerts
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