Representative, Medication Therapy Management Services

JOB DESCRIPTION Job Summary  : Contact Molina Healthcare members to schedule or warm transfer them to the completion of Adherence Reviews, Targeted Medication reviews (TRM's) or Comprehensive Medication reviews (CMRs).  Additionally, the role involves responding to inbound pharmacy-related calls from members providers, pharmacies and clinical staff while ensuring all interactions remain compliant with CMS and NCQA standards.   

Essential Job Duties 
• Educates Molina members on the urgency, positive impacts, and importance of completing an annual comprehensive medication review with pharmacists and maintaining good medication adherence. 
• Enforces Health Insurance Portability and Accountability Act (HIPAA) compliance standards and regulations. 
• Provides clerical services and support to pharmacists and technician staff, and support for day-to-day pharmacy operations as delegated. 
• Adheres to pharmacy policies and procedures related to appropriate call resolution/transfer to internal departments as required. 
• Utilizes appropriate resources to ensure member contact information is current and up-to-date. 
• Effectively communicates general Medicare and Medicaid plan benefits to existing pharmacy members. 
• Interacts with appropriate primary care providers to ensure member registry is current and accurate. 
• Supports pharmacists with completion of comprehensive medication reviews through pre-work up to case preparation. 
• Proactively identifies ways to improve member relations. 
• Supports goal to achieve and maintain industry-leading Medicare STAR ratings.

• Role is 100% Remote 

 

Required Qualifications 
• At least 1 year of related experience, including call center or customer service experience, or equivalent experience combination of relevant education and experience. 
• Excellent customer service skills. 
• Ability to work independently when assigned special projects, such as pill box requests, care management referrals, over the counter (OTC) requests, etc. 
• Ability to multi-task applications while speaking with members. 
• Ability to develop and maintain positive and effective work relationships with coworkers, clients, members, providers, regulatory agencies, and vendors. 
• Ability to meet established deadlines. 
• Ability to function independently and manage multiple projects. 
• Excellent verbal and written communication skills, including excellent phone etiquette. 
• Microsoft Office suite, and applicable software program(s) proficiency. 

Preferred Qualifications 
• Health care industry experience. 
• Pharmacy related 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