Representative, Medication Therapy Management Services

Molina Healthcare • Wisconsin, Wisconsin • 2h ago

JOB DESCRIPTION

Job Summary

Provides 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.

Shift: 10-6:30 PM MST

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.

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

Pay Range: $15 - $28.82 / HOURLY

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Similar Jobs

Nurse Consultant, IRIS (Must reside in WI)

Molina Healthcare • Fitchburg, WI • 34min ago

Hospital & Medical

JOB DESCRIPTION Job Summary Provides clinical consultation for IRIS participants requiring clinical expertise. IRIS nurse consultants train IRIS Consultant Agency (ICA) staff on clinical conditions and equipment, and ser...

34min ago

Go to Apply

RN Clinical Appeals Nurse Remote

Molina Healthcare • Kenosha, WI • 36min ago

Hospital & Medical

JOB DESCRIPTION Job Summary The RN Clinical Appeals Nurse provides support for internal appeals clinical processes - ensuring that appeals requests are reevaluated in alignment with applicable federal and state regulator...

36min ago

Go to Apply

RN Clinical Appeals Nurse Remote

Molina Healthcare • Racine, WI • 36min ago

Hospital & Medical

36min ago

Go to Apply

RN Clinical Appeals Nurse Remote

Molina Healthcare • Green Bay, WI • 36min ago

Hospital & Medical

36min ago

Go to Apply

RN Clinical Appeals Nurse Remote

Molina Healthcare • Milwaukee, WI • 36min ago

Hospital & Medical

36min ago

Go to Apply

RN Clinical Appeals Nurse Remote

Molina Healthcare • Madison, WI • 36min ago

Hospital & Medical

36min ago

Go to Apply

RN Clinical Appeals Nurse Remote

Molina Healthcare • Wisconsin, Wisconsin • 48min ago

Hospital & Medical

48min ago

Go to Apply

Registered Nurse - Inpatient Resource Team - RN

Mayo Clinic • La Crosse, WI • 1h ago

Hospital & Medical

Why Mayo Clinic Mayo Clinic is top-ranked in more specialties than any other care provider according to U.S. News & World Report. As we work together to put the needs of the patient first, we are also dedicated to ou...

1h ago

Go to Apply