Specialist, Pharmacy Operations (Medicaid/ PBM experience)

JOB DESCRIPTION Job SummaryProvides support for pharmacy delegated service activities. Responsible for implementation of new products/services and existing business management. Contributes to overarching pharmacy strategy of optimization of medication related health care outcomes, and quality cost-effective member care.




Essential 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