Mgr, Pharmacy Ops Pharmacy Benefit Management (PBM)- Remote - Hiring Immediately

Job Summary

The Mgr, Pharmacy Operations (PBM) is responsible for the oversight of delegated services, implementation of new products and services, and maintenance of business. Leads and manages a team of Pharmacy Operations Analysts (POA) who are the primary contact for affiliated health plans, Pharmacy Benefit Managers and Corporate shared services with respect to pharmacy operations. Active collaborator with people who are responsible for internal business projects and programs involving department and or cross-functional teams of subject matter experts, delivering products through the design process to completion.  Plans and directs schedules as well as budgets.  Monitors the project from inception through delivery.  Will engage and oversee the work of external vendors.  Will apply subject matter expertise in projects and team development.  Focuses on process improvement, organizational change management, program management, and other process relative to the business.  Ensures comprehensive pre- and post-implementation testing and monitoring is completed.  Coordinates reviews and escalations internally and with external vendors.

Knowledge/Skills/Abilities

• Manage team responsible for internal business projects and programs involving department or cross functional teams of subject matter experts, delivering products through the design process to completion


• Support Medicaid, and Marketplace lines of business


• Surveillance and Oversight of delegated functions:
  
  
  
  • Analyze and interpret data to identify erroneous execution of the pharmacy benefit by the PBM
  
  
  • Review the daily inventory of “outliers” and remediate as required
  
  
  • Review protocols for accuracy and compliance. Includes: Claims, Contracts, Overrides, Network, Digital, etc.
  
  
  • Support internal/external audits
  
  
  • Monitoring state and federal landscape for new opportunities
  
  


• Collaborate with cross functional partners to implement new products and services, as well as support the maintenance of existing business
  
  
  
  • Develop and maintain requirements, user stories, test scenarios and test cases
  
  
  • Support testing execution and defect management
  
  


• Review and interpret member’s eligibility, claim history, and pharmacy benefit information using the PBM claims software to provide information to both internal and external clients


• Serve as a PBM liaison and other internal teams for real-time support on pharmacy benefit interpretation or issues


• Identify and assist to remediate gaps and/or deficiencies in current processes, tools, reports, and dashboards


• Develop and maintain job aids, policies, and process documents


• Develop team members acumen in pharmacy services and Molina products


• Other responsibilities as required

Job Qualifications

REQUIRED EDUCATION:

Bachelor’s Degree

REQUIRED EXPERIENCE:

• Must have strong data analysis skills and attention to detail


• 5-7 years’ experience with pharmacy benefit management


• Strong organizational, problem solving, communication, and interpersonal skills


• Excellent written and oral communication skills required


• Must be able to multitask and be results oriented


• 5-7 years’ experience in a Microsoft Windows environment, including Excel and Access


• 5-7 years’ experience in a managed care or PBM environment required


• 4+ years of Managed Medicaid or Health Exchanges required

PHYSICAL DEMANDS:

Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in an office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function.

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.

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