Molina Healthcare is a FORTUNE 500 company that is focused exclusively on government-sponsored health care programs for families and individuals who qualify for government sponsored health care.
Molina Healthcare contracts with state governments and serves as a health plan providing a wide range of quality health care services to families and individuals.
Molina Healthcare offers health plans in Arizona, California, Florida, Idaho, Illinois, Kentucky, Massachusetts, Michigan, Mississippi, Nevada, New Mexico, New York, Ohio, South Carolina, Texas, Utah, Virginia, Washington and Wisconsin.
Job Description For Molina Healthcare Remote Jobs USA 2024
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).
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.
We wish you the best of luck in your Molina Healthcare Remote Jobs USA 2024. May your talents shine, and may you find the perfect opportunity that not only meets your professional goals but also brings joy to your everyday work.
