Molina Healthcare Operations Analyst, Pharmacy in Las Vegas, Nevada
The Analyst, Pharmacy Operations (POA) is responsible for the oversight of delegated services, implementation of new products and services and maintenance of business. The POA will be the primary contact for affiliated health plans, Pharmacy Benefit Managers and Corporate shared services with respect to pharmacy operations. This role is very dynamic, and the department is fast pace, requiring attention to detail, deep analysis and excellent communication.
• Support Medicaid, and Marketplace lines of business
• Surveillance and Oversight of delegated functions:
o Analyze and interpret data to identify erroneous execution of the pharmacy benefit by the PBM
o Review the daily inventory of “outliers” and remediate as required
o Review protocols for accuracy and compliance. Includes: Claims, Network, Digital, etc.
o Support internal/external audits
o 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
o Develop and maintain requirements, user stories, test scenarios and test cases
o 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
• Other responsibilities as required.
High School Diploma
Must have strong data analysis skills and attention to detail
3-5 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
3-5 years' experience in a Microsoft Windows environment, including Excel and Access
3-5 years' experience in a managed care of PBM environment
2+ years of Managed Medicaid or Health Exchanges
Preferred License, Certification, Association
National Certified Pharmacy Technician (CPhT) certification, preferred
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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