Experienced Remote Pharmacy Technician - Prior Authorization Specialist for Medicaid and Marketplace Members

Join a Culture of Excellence and Collaboration at Molina Healthcare

Molina Healthcare is seeking a highly skilled and experienced Pharmacy Technician to join our team as a Prior Authorization Specialist. As a key member of our Utilization Management (UM) Pharmacy team, you will play a critical role in reviewing incoming Prior Authorization requests for Medicaid and Marketplace members, ensuring that they receive access to medically necessary prescription drugs in a cost-effective and safe manner.

About Molina Healthcare

Molina Healthcare is a leading provider of healthcare services to Medicaid and Medicare members, with a strong commitment to improving the health and well-being of our members. Our Pharmacy Services team works tirelessly to ensure that our members have access to the medications they need, while also promoting safe and effective medication use. As a Pharmacy Technician with Molina Healthcare, you will be part of a dynamic team that is dedicated to delivering high-quality healthcare services to our members.

Key Responsibilities

• Review incoming Prior Authorization requests for Medicaid and Marketplace members through both medical and pharmacy benefits.
• Coordinate with pharmacists to make determinations on cases, ensuring that members receive access to medically necessary prescription drugs.
• Perform initial receipt and review of non-formulary or Prior Authorization requests against plan-approved criteria.
• Request additional information from providers as needed to properly evaluate requests.
• Accurately enter online approvals or denials of requests, and carry out simple Prior Authorization requests within established policies and procedures.
• Participate in the development and administration of programs designed to enhance the utilization of targeted drugs and identify cost-saving pharmacy practices.
• Identify and report departmental operational issues and resource needs to appropriate management.
• Assist Molina Member Services, pharmacies, and health plan providers in resolving member prescription claim, Prior Authorization, or pharmacy services access issues.
• Articulate Pharmacy Management policies and procedures to pharmacy/health plan providers, other Molina staff, and others as needed.

Essential Qualifications

To be successful in this role, you will need to possess the following essential qualifications:

• High School Diploma or GED equivalent.
• Active and unrestricted Pharmacy Technician Certification (e.g., CPhT).
• 2 years of experience as a Pharmacy Technician.
• Strong computer skills, with the ability to work within multiple computer systems simultaneously.
• Excellent written and verbal communication skills.
• Ability to work independently and utilize resources effectively.

Preferred Qualifications

While not required, the following qualifications are highly preferred:

• Associate degree.
• 3+ years of experience as a Pharmacy Technician.
• Specialty Pharmacy and Retail Pharmacy experience (at least 3 years).
• Managed care experience.
• MS Note experience.

Skills and Competencies

To excel in this role, you will need to possess the following skills and competencies:

• Strong analytical and problem-solving skills.
• Excellent communication and interpersonal skills.
• Ability to work in a fast-paced environment with multiple priorities.
• Strong organizational and time management skills.
• Proficiency in multiple computer systems and software applications.

Career Growth Opportunities and Learning Benefits

At Molina Healthcare, we are committed to helping our employees grow and develop their careers. As a Pharmacy Technician with our team, you will have access to ongoing training and development opportunities, including:

• Comprehensive onboarding program.
• Ongoing training and education on pharmacy-related topics.
• Opportunities for career advancement within the organization.
• Mentorship and coaching from experienced professionals.

Work Environment and Company Culture

Molina Healthcare is a dynamic and inclusive organization that values diversity and promotes a culture of excellence. As a remote employee, you will have the flexibility to work from home while still being part of a collaborative and supportive team. Our company culture is built on the following core values:

• Commitment to delivering high-quality healthcare services.
• Respect and empathy for our members and employees.
• Innovation and continuous improvement.
• Collaboration and teamwork.

Compensation, Perks, and Benefits

Molina Healthcare offers a competitive benefits and compensation package to our employees, including:

• Competitive salary.
• Comprehensive benefits package, including medical, dental, and vision coverage.
• Paid time off and holidays.
• Opportunities for career advancement and professional growth.
• Flexible work arrangements, including remote work options.

Join Our Team!

If you are a motivated and experienced Pharmacy Technician looking for a new challenge, we encourage you to apply for this exciting opportunity. As a Prior Authorization Specialist with Molina Healthcare, you will play a critical role in ensuring that our members receive access to medically necessary prescription drugs. Apply today to join our team and start making a difference in the lives of our members!