Pharmacy Tech, Prior Auth CPhT or PTCB (Remote) at Molina Healthcare

Long Beach, California, United States -

Full Time

Start Date

Immediate

Expiry Date

12 Oct, 26

Salary

0.0

Posted On

14 Jul, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Prior Authorization, Pharmacy Claims, Managed Care, Medical Necessity Review, HIPAA Compliance, Microsoft Excel, Written Communication, Verbal Communication, Pharmacy Benefit Management, Retail Pharmacy Experience

Industry

Hospitals and Health Care

Description

Molina Healthcare is hiring for a Pharmacy Technician who is State Licensed/Certified and/or PTCB certified. This role is 100% remote, and the hours will be Mon-Fri 10am to 630pm Pacific Standard Time. This role will be reviewing prior authorization requests for medications to be reviewed by the RPh’s and or MD’s for determination, assisting in determining medical necessity for medications along with assisting with pharmacy claims. Highly qualified candidates for this role will have the following experience- * 2+ years in a retail setting * Prior Authorization experience * Must be computer savvy- able to work within several computer systems at once * Managed care experience * High level of communication skills, both written and verbal Essential Job Duties * Provides support for pharmacy technician activities. Contributes to overarching pharmacy strategy for optimization of medication related health care outcomes, and quality cost-effective member care. * Performs initial receipt and review of non-formulary or prior authorization requests against pharmacy plan approved criteria; requests additional information from providers as needed to properly evaluate requests. * Accurately enters approvals or denials of requests. * Facilitates prior authorization requests within established pharmacy policies and procedures. * Participates in the development/administration of pharmacy programs designed to enhance the utilization of targeted drugs and identification of cost-saving pharmacy practices. * Identifies and reports pharmacy departmental operational issues and resource needs to appropriate leadership. * Assists Molina member services, pharmacies, and health plan providers in resolving member prescription claims, prior authorizations, and pharmacy service access issues. * Articulates pharmacy management policies and procedures to pharmacy/health plan providers, Molina staff and others as needed Required Qualifications * At least 2 years pharmacy technician experience, or equivalent combination of relevant education and 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. * Ability to abide by Molina policies. * Ability to maintain attendance to support required quality and quantity of work. * Ability to maintain confidentiality and comply with the Health Insurance Portability and Accountability Act (HIPAA). * Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers. * Excellent verbal and written communication skills. * Microsoft Office suite (including Excel), and applicable software program(s) proficiency. 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 Key Words: Pharmacy Technician, Pharm Tech, Tech, National Certification, State License, Certification, Claims, Pharmacy Claims, Pharmacy, PBM, National Certified Pharmacy Technician (CPhT) certification, Medicaid, Medicare, Managed Care, MCO, Exchange, PBM, Pharmacy Benefit Management, Prior Auth

Responsibilities

Review prior authorization requests for medications to determine medical necessity and assist with pharmacy claims. Support pharmacy strategy to optimize healthcare outcomes and coordinate with providers and members to resolve prescription issues.