Representative, Medication Therapy Management Services (Must be bilingual in Spanish)

Molina Healthcare • Kenosha, WI • 7h ago

JOB DESCRIPTION Job SummaryProvides customer service support for inbound/outbound Medication Therapy Management (MTM) pharmacy calls from members, providers, and pharmacies. Contributes to overarching pharmacy strategy for optimization of medication related health care outcomes, and quality cost-effective member care.

Essential Job Duties

Handles and records inbound/outbound pharmacy calls with members, providers, pharmacists, pharmacies and technicians - ensuring departmental and Centers for Medicare and Medicaid Services (CMS) standards are met.

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.

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.

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