Pharmacy Technician Prior Auth Review Remote EST / EST

Molina Healthcare
US - Wisconsin - Milwaukee
January 15, 2025

Molina Healthcare is hiring for Pharmacy Technicians who are State Licensed/Certified and/or PTCB certified.

This role is 100% remote, and the hours will be Mon-Fri 9am to 530pm or 11am to 730pm Eastern 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-

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
Call center experience

Molina Pharmacy Services/Management staff work to ensure that Molina members 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

Performs initial receipt and review of non-formulary or prior authorization requests against plan approved criteria. Requests additional information from providers as needed to properly evaluate the request.
Accurately enters on-line approvals or denials of requests. Authorized to make and carry out simple prior authorization requests within established policies and procedures.
Participates in the development /administration of programs designed to enhance the utilization of targeted drugs and the identification of cost saving pharmacy practices.
Identifies and reports departmental operational issues and resource needs to appropriate management.
Assists Molina Member Services, pharmacies, and health plan providers in resolving member prescription claim, prior authorization, or pharmacy services access issues.
Articulates Pharmacy Management policies and procedures to pharmacy/health plan providers, other Molina staff and others as needed.

JOB QUALIFICATIONS

Required Education : High School Diploma or GED equivalent

Preferred Education : Associate degree

Required Experience : 2 years' experience as a Pharmacy Technician

Preferred Experience: 3+ years

Required License, Certification, Association : Active and unrestricted 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.

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

Pay Range: $20.29 - $31.71 / HOURLY

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Read the full job description and apply online on the recuiter's web-site

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