Service Associate jobs at HCA Healthcare - 46 jobs

Campus Engagement Specialist
HCA 4.5
Service associate job at HCA Healthcare
Salary Estimate: 42764.80 - 59862.40 / year Learn more about the benefits offered for this job. The estimate displayed represents the typical salary range of candidates hired. Factors that may be used to determine your actual salary may include your specific skills, how many years of experience you have and comparison to other employees already in this role. The typical candidate is hired below midpoint of the range. You Can Change the Life of One to Care for the Lives of Many! At Galen College of Nursing, we educate and empower nurses to change lives. Since 1989, we've dedicated our work to delivering high-quality nursing education with a student-first mindset. As one of the largest private nursing colleges in the country, we combine the support of a close-knit learning environment with the strength of a nationally recognized institution, HCA Healthcare. That same passion for excellence in the classroom extends to our offices. At Galen, you'll find a culture deeply rooted in collaboration, innovation, and a shared commitment to improving the future of healthcare. Your work directly touches the next generation of nurses, and your contributions help our students pursue their dream of a compassionate career. If you're looking for a career where you can make a difference, grow professionally, and be part of a caring team, we'd love for you to apply for the Campus Engagement Specialist position today! Click here to learn more about Galen! Position Overview: As a Campus Engagement Specialist at Galen College of Nursing, you will coordinate campus and student engagement activities, as well as other related services to support student success in the nursing programs and career preparation. This position will collaborate with Galen's faculty, administration, and staff in addressing the needs of a student population with diverse academic, cultural, ethnic, and socioeconomic backgrounds. In addition, the Campus Engagement Specialist will organize career fairs, new student orientation and other campus events. Key Responsibilities: * Collaborate to organize and/or implement graduation and honor ceremony events, as required. * Organize and facilitate new student orientation. * Develop and facilitate career information workshops and career fairs to enhance student/graduate readiness for employment. * Collaborate with the nurse sponsor Galen Student Nurse Association and assist GSNA in planning quarterly programming, as required. * Facilitate the Student Advisory Committee. * Facilitates the Student Veteran's Association. * Recruits, trains, monitors, and coordinates the Student Ambassador and Peer Mentor programs. * Serve as the primary student point of contact for the Student Success Department. * Refers students in need of services to the appropriate Student Success Department staff. * Promote Student Success Department services within the campus. * Monitor, document, and report student utilization of department services * Participate in campus activities including committee work, and campus events. * Serve as the campus-level coordinator for internal investigations of ADA related grievances. * Collaborate with the 504 Coordinator, campus leadership, and Compliance and Regulatory Affairs to ensure that attempts to mediate and resolve complaints are made prior to formal grievance stage. * Assist the 504 Coordinator and campus leadership to ensure that ADA investigations and hearings are conducted according to policies and procedures. Position Requirements: * Education: Bachelor's degree in education, student affairs, social services, counseling, or related field preferred. * Special Qualifications: Microsoft Office computer skills, including Microsoft Word and Microsoft Excel competencies. Student information system program experience preferred. Excellent oral and written communication skills. Must present a professional demeanor and appearance. Must assist in a variety of complex administrative duties involving contact and exposure to proprietary information. Utilizes independent judgement, determining when to act for management and when to refer problems for personal attention. Must have dependable transportation for frequent local travel. Demonstrate dependability and attention to detail. Membership in a professional career services organization is a plus. Physical Requirements: Must be able to sit in front of a computer screen, lift up to 30 pounds, and sit, stand, or walk for extended periods of time. * Degree of Supervision: Minimal Benefits At Galen College of Nursing, we want to ensure your needs are met. We offer a comprehensive package of medical, dental, and vision plans, tuition discounts, along with unique benefits, including: * Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation. * Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance, and more. * Free counseling services and resources for emotional, physical, and financial well-being * 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service) * Employee Stock Purchase Plan with 10% off HCA Healthcare stock * Family support through fertility and family building benefits with Progyny and adoption assistance. * Referral services for children, elders, and pet care, home and auto repair, event planning, and more. * Consumer discounts through Abenity. * Retirement readiness, rollover assistance services, and preferred banking partnerships. * Education assistance (tuition, student loan, certification support, dependent scholarships). * Colleague recognition program. * Time Away from Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence). * Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income. Learn more about Employee Benefits. Note: Eligibility for benefits may vary by location. Galen College of Nursing is recognized as a 2023 National League of Nursing (NLN) Center of Excellence (COE). Galen's Compassionate Care Model Values * Inclusivity: I foster an environment that provides opportunity for every individual to reach their full potential. * Character: I act with integrity and compassion in all I do. * Accountability: I own my role and accept responsibility for my actions. * Respect: I value every person as an individual with unique contributions worthy of consideration. * Excellence: I commit myself to the highest level of quality in everything I do. Learn more about our vision and mission. Experience the HCA Healthcare difference where colleagues are trusted, valued members of our healthcare team. Grow your career with an organization committed to delivering respectful, compassionate care, and where the unique and intrinsic worth of each individual is recognized. Submit your application for the opportunity below: Campus Engagement Specialist Galen College of Nursing
$55k-67k yearly est. 21d ago

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RCM Customer Service Representative - Remote
Tenet Healthcare Corporation 4.5
Frisco, TX jobs
Responsible for answering inbound customer service calls related to patient accounting questions. When inbound call volumes are low incumbent may make outbound follow up calls on outstanding AR accounts. ESSENTIAL DUTIES AND RESPONSIBILITIES Include the following. Others may be assigned. * Answer inbound customer service calls and make some outbound follow up calls in a professional, service-oriented manner. Answer the calls timely without drops/abandons. * Ascertain the reason for the call and assist the caller with their questions, concerns or problems with the focus on first call resolution. Facilitate resolution by referring the matter to the issue/content expert. Escalate the matter to a supervisor, request the appropriate information or take appropriate action so that the issue expert is able to effectively resolve the matter. * Other duties as assigned. KNOWLEDGE, SKILLS, ABILITIES To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. * Exceptional customer service skills including effective and efficient problem solving and analyzing skills * Professional and calming tone of voice with complete command of the English language free of use of inappropriate grammar * Ability to facilitate conversations with others and establish an understanding of the customer's issue/reason for contact * Ability to perform essential job functions with high degree of independence, flexibility, and creative problem-solving techniques * Ability to maintain control of the call by de-escalating issues and instilling confidence that the resolution has been found. * Ability to function effectively under stress of conflicting demands on time and attention and, sometimes, under duress from difficult personalities * Ability to interpret and apply reimbursement aspects of managed healthcare contracts * Attentive listening skills * Ability to clearly articulate a response to the customer using appropriate voice modulation Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings. EDUCATION / EXPERIENCE Include minimum education, technical training, and/or experience preferred to perform the job. * High school education or the equivalent * 1 - 2 years prior experience in an inbound call center and/or customer service environment; hospital patient account billing with experience or knowledge of 3rd party reimbursements from insurance companies and government payers is a plus. PHYSICAL DEMANDS The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. * Ability to sit at a computer terminal for extended periods of time WORK ENVIRONMENT The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. * Call Center environment with headset and multiple workstations within close proximity * Hospital Environment may include direct patient interaction As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step! Compensation and Benefit Information Compensation * Pay: $15.80 - $23.70 per hour. Compensation depends on location, qualifications, and experience. * Position may be eligible for a signing bonus for qualified new hires, subject to employment status. * Conifer observed holidays receive time and a half. Benefits Conifer offers the following benefits, subject to employment status: * Medical, dental, vision, disability, and life insurance * Paid time off (vacation & sick leave) - min of 12 days per year, accrue at a rate of approximately 1.84 hours per 40 hours worked. * 401k with up to 6% employer match * 10 paid holidays per year * Health savings accounts, healthcare & dependent flexible spending accounts * Employee Assistance program, Employee discount program * Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, AD&D, auto & home insurance. * For Colorado employees, Conifer offers paid leave in accordance with Colorado's Healthy Families and Workplaces Act. Employment practices will not be influenced or affected by an applicant's or employee's race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship. Tenet participates in the E-Verify program. Follow the link below for additional information. E-Verify: ***************************** The employment practices of Tenet Healthcare and its companies comply with all applicable laws and regulations. **********
$15.8-23.7 hourly 5d ago
Senior Service Center Representative Banner Plans and Networks
Banner Health 4.4
Remote
Department Name: Banner Staffing Services-AZ Work Shift: Day Job Category: Administrative Services Estimated Pay Range: $20.01 - $30.01 / hour, based on location, education, & experience. In accordance with State Pay Transparency Rules. "Banner Staffing Services (BSS) offers Registry/Per Diem opportunities within Banner Health. Registry/Per Diem positions are utilized as needed within our facilities. These positions are great way to start your career with Banner Health. As a BSS team member, you are eligible to apply (at any time) as an internal applicant to any regular opportunities within Banner Health. Learn more at **************************** As a Senior Service Center Representative for Banner Plans & Networks you will take inbound calls answering member and provider questions regarding coverage, benefits, claims, and other plan inquiries. You will be working in a fast paced and multitasking environment. You will provide excellent customer service and satisfaction with a goal of first call resolution. As a Senior Service Center Representative, you will be working in a remote setting. Your shifts will be Monday-Friday between 8am-8pm, Arizona Time Zone. (Some after-hours or weekends may be required for certain types of training. Advanced notification will be provided when this is necessary.) Please note Banner Staffing Services roles do not offer medical benefits or paid time off accrual. These roles are assignment based with no guarantee of hours and assignments can conclude at any time. If this role sounds like the one for you, Apply Today! As a valued and respected Banner Health team member, you will enjoy: Competitive wages Paid orientation Flexible Schedules (select positions) Fewer Shifts Cancelled Weekly pay 403(b) Pre-tax retirement Resources for living (Employee Assistance Program) MyWell-Being (Wellness program) Discount Entertainment tickets Restaurant/Shopping discounts Registry/Per Diem positions do not have guaranteed hours and no medical benefits package is offered. Completion of post-offer Occupational Health physical assessment, drug screen and background check (includes employment, criminal and education) is required. POSITION SUMMARY This position provides leadership and expertise to the representatives providing customer service to providers and members of benefit plans; supports the development of the company health plans as well as the staff by coordinating the training, documentation, client communication techniques, and other resources necessary to ensure an excellent quality of service. This position serves as a primary resource in complex and/or sensitive cases and takes escalated calls. May be assigned to work in a variety of team leadership, work flow management and/or quality assurance functions. CORE FUNCTIONS 1. Provides customer service, researches and solves problems for escalated calls and member or provider issues requiring investigation and problem solving. 2. Provides training and informational/reference resources for the service center. 3. Maintains records, tracks cases, issues correspondence and log events for assigned area of benefits services. 4. Provides direction and leadership in daily work and workflow of a service center team. 5. Works on special projects as assigned. 7. Works under limited supervision to provide for diverse customer service needs for multiple benefit plans. Interprets company and contracted managed care organization policy and procedure. Makes decisions within structured definitions and defined policy. This position manages diverse customer needs while positioning services and programs as the preferred choice for meeting the stated needs. This position independently interprets benefits and managed care policies and procedures and communicates accordingly to customer base, following general guidelines and standards, this position will determine appropriate action to meet customer needs. MINIMUM QUALIFICATIONS High school diploma/GED or equivalent working knowledge. Must have substantial previous related work experience in managed care benefits member/provider services work are required, with three to fours years of experience in a high volume service center or managed care environment, preferably with self-insured plans. Must possess excellent communication skills to handle moderately complex inquiries, while maintaining a positive and helpful attitude. Requires the ability to handle a high volume of incoming calls, search the database or resources tools for correct and timely information, and maintain a professional demeanor all times. Must have the ability to learn and effectively use the company's customer information systems, as well as developing and maintaining a fundamental knowledge of the organization's benefit plans. PREFERRED QUALIFICATIONS Experience working with self insured plans is highly preferred. Bilingual Spanish/English skills are a plus. Additional related education and/or experience preferred. EEO Statement: EEO/Disabled/Veterans Our organization supports a drug-free work environment. Privacy Policy: Privacy Policy
$20-30 hourly Auto-Apply 2d ago
Representative, Pharmacy
Molina Healthcare Inc. 4.4
Columbus, OH jobs
Provides customer service support for inbound/outbound 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 Available:12:30-9 PM MST Essential Job Duties * Handles and records inbound/outbound pharmacy calls from members, providers and pharmacies in accordance with departmental policies, state regulations, National Committee of Quality Assurance (NCQA) guidelines, and Centers for Medicare and Medicaid Services (CMS) standards. * Provides coordination and processing of pharmacy prior authorization requests and/or appeals. * Explains point-of-sale claims adjudication, state, NCQA and CMS policies/guidelines, and any other necessary information to providers, members and pharmacies. * Assists with clerical tasks and other day-to-day pharmacy call center operations as delegated. * Effectively communicates plan benefit information, including but not limited to: formulary information, copay amounts, pharmacy location services and prior authorization outcomes. * Assists members and providers with initiating verbal and written coverage determinations and appeals. * Records calls accurately within the pharmacy call tracking system. * Maintains established pharmacy call quality and quantity standards. * Interacts with appropriate primary care providers to ensure member registry is current and accurate. * Supports pharmacists with completion of comprehensive medication reviews (CMRs)through pre-work up to case preparation. * Proactively identifies ways to improve pharmacy call center member relations. Required Qualifications * At least 1 year related experience, including call center or customer service experience, or equivalent combination of relevant education and experience. * Excellent customer service skills. * Ability to work independently when assigned special projects, such as pill box requests, case management referrals, over the counter (OTC) requests, etc. * Ability to multi-task applications while speaking with members. * 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 (including Excel), and applicable software program(s) proficiency. Preferred Qualifications * Certified Pharmacy Technician (CPhT) and/or state pharmacy technician license (state specific if state required). If licensed, license must be active and unrestricted in state of practice. * Health care industry 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: $21.65 - $28.82 / HOURLY * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
$21.7-28.8 hourly 37d ago
Representative, Pharmacy
Molina Healthcare 4.4
Columbus, OH jobs
Provides customer service support for inbound/outbound 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 Available:** **12:30-9 PM MST** **Essential Job Duties** - Handles and records inbound/outbound pharmacy calls from members, providers and pharmacies in accordance with departmental policies, state regulations, National Committee of Quality Assurance (NCQA) guidelines, and Centers for Medicare and Medicaid Services (CMS) standards. - Provides coordination and processing of pharmacy prior authorization requests and/or appeals. - Explains point-of-sale claims adjudication, state, NCQA and CMS policies/guidelines, and any other necessary information to providers, members and pharmacies. - Assists with clerical tasks and other day-to-day pharmacy call center operations as delegated. - Effectively communicates plan benefit information, including but not limited to: formulary information, copay amounts, pharmacy location services and prior authorization outcomes. - Assists members and providers with initiating verbal and written coverage determinations and appeals. - Records calls accurately within the pharmacy call tracking system. - Maintains established pharmacy call quality and quantity standards. - Interacts with appropriate primary care providers to ensure member registry is current and accurate. - Supports pharmacists with completion of comprehensive medication reviews (CMRs)through pre-work up to case preparation. - Proactively identifies ways to improve pharmacy call center member relations. **Required Qualifications** - At least 1 year related experience, including call center or customer service experience, or equivalent combination of relevant education and experience. - Excellent customer service skills. - Ability to work independently when assigned special projects, such as pill box requests, case management referrals, over the counter (OTC) requests, etc. - Ability to multi-task applications while speaking with members. - 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 (including Excel), and applicable software program(s) proficiency. **Preferred Qualifications** - Certified Pharmacy Technician (CPhT) and/or state pharmacy technician license (state specific if state required). If licensed, license must be active and unrestricted in state of practice. - Health care industry 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: $21.65 - $28.82 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
$21.7-28.8 hourly 36d ago
Representative, Provider Relations HP (Idaho HealthPlan)
Molina Healthcare Inc. 4.4
Ohio jobs
Molina Health Plan Network Provider Relations jobs are responsible for network development, network adequacy and provider training and education, in alignment with Molina Healthcare's overall mission, core values, and strategic plan and in compliance with all relevant federal, state and local regulations. Provider Relations staff are the primary point of contact between Molina Healthcare and contracted provider network. They are responsible for network management including provider education, communication, satisfaction, issue intake, access/availability and ensuring knowledge of and compliance with Molina healthcare policies and procedures while achieving the highest level of customer service. Job Duties This role serves as the primary point of contact between Molina Health plan and the for non-complex Provider Community that services Molina members, including but not limited to Fee-For-Service and Pay for Performance Providers, focusing on FQHC, large provider groups, and Behavioral Health. It is an external-facing, field-based position requiring a high degree of job knowledge, communication and organizational skills to successfully engage high volume, high visibility providers, including senior leaders and physicians, to ensure provider satisfaction, education on key Molina initiatives, and improved coordination and partnership. * Under minimal direction, works directly with the Plan's external providers to educate, advocate and engage as valuable partners, ensuring knowledge of and compliance with Molina policies and procedures while achieving the highest level of customer service. Effectiveness in driving timely issue resolution, EMR connectivity, Provider Portal Adoption. * Conducts regular provider site visits within assigned region/service area. Determines own daily or weekly schedule, as needed to meet or exceed the Plan's monthly site visit goals. A key responsibility of the Representative during these visits is to proactively engage with the provider and staff to determine; for example, non-compliance with Molina policies/procedures or CMS guidelines/regulations, or to assess the non-clinical quality of customer service provided to Molina members. * Provides on-the-spot training and education as needed, which may include counseling providers diplomatically, while retaining a positive working relationship. * Independently troubleshoots problems as they arise, making an assessment when escalation to a Senior Representative, Supervisor, or another Molina department is needed. Takes initiative in preventing and resolving issues between the provider and the Plan whenever possible. The types of questions, issues or problems that may emerge during visits are unpredictable and may range from simple to very complex or sensitive matters. * Initiates, coordinates and participates in problem-solving meetings between the provider and Molina stakeholders, including senior leadership and physicians. For example, such meetings would occur to discuss and resolve issues related to utilization management, pharmacy, quality of care, and correct coding. * Independently delivers training and presentations to assigned providers and their staff, answering questions that come up on behalf of the Health plan. May also deliver training and presentations to larger groups, such as leaders and management of provider offices (including large multispecialty groups or health systems, executive level decision makers, Association meetings, and JOC's). * Performs an integral role in network management, by monitoring and enforcing company policies and procedures, while increasing provider effectiveness by educating and promoting participation in various Molina initiatives. Examples of such initiatives include: administrative cost effectiveness, member satisfaction - CAHPS, regulatory-related, Molina Quality programs, and taking advantage of electronic solutions (EDI, EFT, EMR, Provider Portal, Provider Website, etc.). * Trains other Provider Relations Representatives as appropriate. * Role requires 30+% same-day or overnight travel. (Extent of same-day or overnight travel will depend on the specific Health Plan and its service area.) Job Qualifications REQUIRED EDUCATION: Associate's Degree or equivalent provider contract, network development and management, or project management experience in a managed healthcare setting. REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES: * 2 - 3 years customer service, provider service, or claims experience in a managed care setting. * Working familiarity with various managed healthcare provider compensation methodologies, primarily across Medicaid and Medicare lines of business, including but not limited to, fee-for service, capitation and various forms of risk, ASO, etc. PREFERRED EDUCATION: Bachelor's Degree in a related field or an equivalent combination of education and experience PREFERRED EXPERIENCE: * 3+ years experience in managed healthcare administration and/or Provider Services. * FQHC, large provider groups, and Behavioral Health 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. Pay Range: $17.85 - $38.69 / HOURLY * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
$17.9-38.7 hourly 13d ago
Representative, Pharmacy
Molina Healthcare Inc. 4.4
Cleveland, OH jobs
Provides customer service support for inbound/outbound 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 Available:12:30-9 PM MST Essential Job Duties * Handles and records inbound/outbound pharmacy calls from members, providers and pharmacies in accordance with departmental policies, state regulations, National Committee of Quality Assurance (NCQA) guidelines, and Centers for Medicare and Medicaid Services (CMS) standards. * Provides coordination and processing of pharmacy prior authorization requests and/or appeals. * Explains point-of-sale claims adjudication, state, NCQA and CMS policies/guidelines, and any other necessary information to providers, members and pharmacies. * Assists with clerical tasks and other day-to-day pharmacy call center operations as delegated. * Effectively communicates plan benefit information, including but not limited to: formulary information, copay amounts, pharmacy location services and prior authorization outcomes. * Assists members and providers with initiating verbal and written coverage determinations and appeals. * Records calls accurately within the pharmacy call tracking system. * Maintains established pharmacy call quality and quantity standards. * Interacts with appropriate primary care providers to ensure member registry is current and accurate. * Supports pharmacists with completion of comprehensive medication reviews (CMRs)through pre-work up to case preparation. * Proactively identifies ways to improve pharmacy call center member relations. Required Qualifications * At least 1 year related experience, including call center or customer service experience, or equivalent combination of relevant education and experience. * Excellent customer service skills. * Ability to work independently when assigned special projects, such as pill box requests, case management referrals, over the counter (OTC) requests, etc. * Ability to multi-task applications while speaking with members. * 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 (including Excel), and applicable software program(s) proficiency. Preferred Qualifications * Certified Pharmacy Technician (CPhT) and/or state pharmacy technician license (state specific if state required). If licensed, license must be active and unrestricted in state of practice. * Health care industry 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: $21.65 - $28.82 / HOURLY * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
$21.7-28.8 hourly 37d ago
Representative, Pharmacy
Molina Healthcare 4.4
Cleveland, OH jobs
Provides customer service support for inbound/outbound 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 Available:** **12:30-9 PM MST** **Essential Job Duties** - Handles and records inbound/outbound pharmacy calls from members, providers and pharmacies in accordance with departmental policies, state regulations, National Committee of Quality Assurance (NCQA) guidelines, and Centers for Medicare and Medicaid Services (CMS) standards. - Provides coordination and processing of pharmacy prior authorization requests and/or appeals. - Explains point-of-sale claims adjudication, state, NCQA and CMS policies/guidelines, and any other necessary information to providers, members and pharmacies. - Assists with clerical tasks and other day-to-day pharmacy call center operations as delegated. - Effectively communicates plan benefit information, including but not limited to: formulary information, copay amounts, pharmacy location services and prior authorization outcomes. - Assists members and providers with initiating verbal and written coverage determinations and appeals. - Records calls accurately within the pharmacy call tracking system. - Maintains established pharmacy call quality and quantity standards. - Interacts with appropriate primary care providers to ensure member registry is current and accurate. - Supports pharmacists with completion of comprehensive medication reviews (CMRs)through pre-work up to case preparation. - Proactively identifies ways to improve pharmacy call center member relations. **Required Qualifications** - At least 1 year related experience, including call center or customer service experience, or equivalent combination of relevant education and experience. - Excellent customer service skills. - Ability to work independently when assigned special projects, such as pill box requests, case management referrals, over the counter (OTC) requests, etc. - Ability to multi-task applications while speaking with members. - 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 (including Excel), and applicable software program(s) proficiency. **Preferred Qualifications** - Certified Pharmacy Technician (CPhT) and/or state pharmacy technician license (state specific if state required). If licensed, license must be active and unrestricted in state of practice. - Health care industry 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: $21.65 - $28.82 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
$21.7-28.8 hourly 36d ago
Representative, Pharmacy
Molina Healthcare Inc. 4.4
Dayton, OH jobs
Provides customer service support for inbound/outbound 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 Available:12:30-9 PM MST Essential Job Duties * Handles and records inbound/outbound pharmacy calls from members, providers and pharmacies in accordance with departmental policies, state regulations, National Committee of Quality Assurance (NCQA) guidelines, and Centers for Medicare and Medicaid Services (CMS) standards. * Provides coordination and processing of pharmacy prior authorization requests and/or appeals. * Explains point-of-sale claims adjudication, state, NCQA and CMS policies/guidelines, and any other necessary information to providers, members and pharmacies. * Assists with clerical tasks and other day-to-day pharmacy call center operations as delegated. * Effectively communicates plan benefit information, including but not limited to: formulary information, copay amounts, pharmacy location services and prior authorization outcomes. * Assists members and providers with initiating verbal and written coverage determinations and appeals. * Records calls accurately within the pharmacy call tracking system. * Maintains established pharmacy call quality and quantity standards. * Interacts with appropriate primary care providers to ensure member registry is current and accurate. * Supports pharmacists with completion of comprehensive medication reviews (CMRs)through pre-work up to case preparation. * Proactively identifies ways to improve pharmacy call center member relations. Required Qualifications * At least 1 year related experience, including call center or customer service experience, or equivalent combination of relevant education and experience. * Excellent customer service skills. * Ability to work independently when assigned special projects, such as pill box requests, case management referrals, over the counter (OTC) requests, etc. * Ability to multi-task applications while speaking with members. * 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 (including Excel), and applicable software program(s) proficiency. Preferred Qualifications * Certified Pharmacy Technician (CPhT) and/or state pharmacy technician license (state specific if state required). If licensed, license must be active and unrestricted in state of practice. * Health care industry 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: $21.65 - $28.82 / HOURLY * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
$21.7-28.8 hourly 37d ago
Representative, Pharmacy
Molina Healthcare 4.4
Dayton, OH jobs
Provides customer service support for inbound/outbound 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 Available:** **12:30-9 PM MST** **Essential Job Duties** - Handles and records inbound/outbound pharmacy calls from members, providers and pharmacies in accordance with departmental policies, state regulations, National Committee of Quality Assurance (NCQA) guidelines, and Centers for Medicare and Medicaid Services (CMS) standards. - Provides coordination and processing of pharmacy prior authorization requests and/or appeals. - Explains point-of-sale claims adjudication, state, NCQA and CMS policies/guidelines, and any other necessary information to providers, members and pharmacies. - Assists with clerical tasks and other day-to-day pharmacy call center operations as delegated. - Effectively communicates plan benefit information, including but not limited to: formulary information, copay amounts, pharmacy location services and prior authorization outcomes. - Assists members and providers with initiating verbal and written coverage determinations and appeals. - Records calls accurately within the pharmacy call tracking system. - Maintains established pharmacy call quality and quantity standards. - Interacts with appropriate primary care providers to ensure member registry is current and accurate. - Supports pharmacists with completion of comprehensive medication reviews (CMRs)through pre-work up to case preparation. - Proactively identifies ways to improve pharmacy call center member relations. **Required Qualifications** - At least 1 year related experience, including call center or customer service experience, or equivalent combination of relevant education and experience. - Excellent customer service skills. - Ability to work independently when assigned special projects, such as pill box requests, case management referrals, over the counter (OTC) requests, etc. - Ability to multi-task applications while speaking with members. - 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 (including Excel), and applicable software program(s) proficiency. **Preferred Qualifications** - Certified Pharmacy Technician (CPhT) and/or state pharmacy technician license (state specific if state required). If licensed, license must be active and unrestricted in state of practice. - Health care industry 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: $21.65 - $28.82 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
$21.7-28.8 hourly 36d ago
Representative, Pharmacy
Molina Healthcare Inc. 4.4
Akron, OH jobs
Provides customer service support for inbound/outbound 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 Available:12:30-9 PM MST Essential Job Duties * Handles and records inbound/outbound pharmacy calls from members, providers and pharmacies in accordance with departmental policies, state regulations, National Committee of Quality Assurance (NCQA) guidelines, and Centers for Medicare and Medicaid Services (CMS) standards. * Provides coordination and processing of pharmacy prior authorization requests and/or appeals. * Explains point-of-sale claims adjudication, state, NCQA and CMS policies/guidelines, and any other necessary information to providers, members and pharmacies. * Assists with clerical tasks and other day-to-day pharmacy call center operations as delegated. * Effectively communicates plan benefit information, including but not limited to: formulary information, copay amounts, pharmacy location services and prior authorization outcomes. * Assists members and providers with initiating verbal and written coverage determinations and appeals. * Records calls accurately within the pharmacy call tracking system. * Maintains established pharmacy call quality and quantity standards. * Interacts with appropriate primary care providers to ensure member registry is current and accurate. * Supports pharmacists with completion of comprehensive medication reviews (CMRs)through pre-work up to case preparation. * Proactively identifies ways to improve pharmacy call center member relations. Required Qualifications * At least 1 year related experience, including call center or customer service experience, or equivalent combination of relevant education and experience. * Excellent customer service skills. * Ability to work independently when assigned special projects, such as pill box requests, case management referrals, over the counter (OTC) requests, etc. * Ability to multi-task applications while speaking with members. * 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 (including Excel), and applicable software program(s) proficiency. Preferred Qualifications * Certified Pharmacy Technician (CPhT) and/or state pharmacy technician license (state specific if state required). If licensed, license must be active and unrestricted in state of practice. * Health care industry 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: $21.65 - $28.82 / HOURLY * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
$21.7-28.8 hourly 37d ago
Representative, Pharmacy
Molina Healthcare Inc. 4.4
Cincinnati, OH jobs
Provides customer service support for inbound/outbound 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 Available:12:30-9 PM MST Essential Job Duties * Handles and records inbound/outbound pharmacy calls from members, providers and pharmacies in accordance with departmental policies, state regulations, National Committee of Quality Assurance (NCQA) guidelines, and Centers for Medicare and Medicaid Services (CMS) standards. * Provides coordination and processing of pharmacy prior authorization requests and/or appeals. * Explains point-of-sale claims adjudication, state, NCQA and CMS policies/guidelines, and any other necessary information to providers, members and pharmacies. * Assists with clerical tasks and other day-to-day pharmacy call center operations as delegated. * Effectively communicates plan benefit information, including but not limited to: formulary information, copay amounts, pharmacy location services and prior authorization outcomes. * Assists members and providers with initiating verbal and written coverage determinations and appeals. * Records calls accurately within the pharmacy call tracking system. * Maintains established pharmacy call quality and quantity standards. * Interacts with appropriate primary care providers to ensure member registry is current and accurate. * Supports pharmacists with completion of comprehensive medication reviews (CMRs)through pre-work up to case preparation. * Proactively identifies ways to improve pharmacy call center member relations. Required Qualifications * At least 1 year related experience, including call center or customer service experience, or equivalent combination of relevant education and experience. * Excellent customer service skills. * Ability to work independently when assigned special projects, such as pill box requests, case management referrals, over the counter (OTC) requests, etc. * Ability to multi-task applications while speaking with members. * 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 (including Excel), and applicable software program(s) proficiency. Preferred Qualifications * Certified Pharmacy Technician (CPhT) and/or state pharmacy technician license (state specific if state required). If licensed, license must be active and unrestricted in state of practice. * Health care industry 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: $21.65 - $28.82 / HOURLY * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
$21.7-28.8 hourly 37d ago
Representative, Pharmacy
Molina Healthcare 4.4
Cincinnati, OH jobs
Provides customer service support for inbound/outbound 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 Available:** **12:30-9 PM MST** **Essential Job Duties** - Handles and records inbound/outbound pharmacy calls from members, providers and pharmacies in accordance with departmental policies, state regulations, National Committee of Quality Assurance (NCQA) guidelines, and Centers for Medicare and Medicaid Services (CMS) standards. - Provides coordination and processing of pharmacy prior authorization requests and/or appeals. - Explains point-of-sale claims adjudication, state, NCQA and CMS policies/guidelines, and any other necessary information to providers, members and pharmacies. - Assists with clerical tasks and other day-to-day pharmacy call center operations as delegated. - Effectively communicates plan benefit information, including but not limited to: formulary information, copay amounts, pharmacy location services and prior authorization outcomes. - Assists members and providers with initiating verbal and written coverage determinations and appeals. - Records calls accurately within the pharmacy call tracking system. - Maintains established pharmacy call quality and quantity standards. - Interacts with appropriate primary care providers to ensure member registry is current and accurate. - Supports pharmacists with completion of comprehensive medication reviews (CMRs)through pre-work up to case preparation. - Proactively identifies ways to improve pharmacy call center member relations. **Required Qualifications** - At least 1 year related experience, including call center or customer service experience, or equivalent combination of relevant education and experience. - Excellent customer service skills. - Ability to work independently when assigned special projects, such as pill box requests, case management referrals, over the counter (OTC) requests, etc. - Ability to multi-task applications while speaking with members. - 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 (including Excel), and applicable software program(s) proficiency. **Preferred Qualifications** - Certified Pharmacy Technician (CPhT) and/or state pharmacy technician license (state specific if state required). If licensed, license must be active and unrestricted in state of practice. - Health care industry 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: $21.65 - $28.82 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
$21.7-28.8 hourly 36d ago
Representative, Pharmacy
Molina Healthcare 4.4
Akron, OH jobs
Provides customer service support for inbound/outbound 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 Available:** **12:30-9 PM MST** **Essential Job Duties** - Handles and records inbound/outbound pharmacy calls from members, providers and pharmacies in accordance with departmental policies, state regulations, National Committee of Quality Assurance (NCQA) guidelines, and Centers for Medicare and Medicaid Services (CMS) standards. - Provides coordination and processing of pharmacy prior authorization requests and/or appeals. - Explains point-of-sale claims adjudication, state, NCQA and CMS policies/guidelines, and any other necessary information to providers, members and pharmacies. - Assists with clerical tasks and other day-to-day pharmacy call center operations as delegated. - Effectively communicates plan benefit information, including but not limited to: formulary information, copay amounts, pharmacy location services and prior authorization outcomes. - Assists members and providers with initiating verbal and written coverage determinations and appeals. - Records calls accurately within the pharmacy call tracking system. - Maintains established pharmacy call quality and quantity standards. - Interacts with appropriate primary care providers to ensure member registry is current and accurate. - Supports pharmacists with completion of comprehensive medication reviews (CMRs)through pre-work up to case preparation. - Proactively identifies ways to improve pharmacy call center member relations. **Required Qualifications** - At least 1 year related experience, including call center or customer service experience, or equivalent combination of relevant education and experience. - Excellent customer service skills. - Ability to work independently when assigned special projects, such as pill box requests, case management referrals, over the counter (OTC) requests, etc. - Ability to multi-task applications while speaking with members. - 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 (including Excel), and applicable software program(s) proficiency. **Preferred Qualifications** - Certified Pharmacy Technician (CPhT) and/or state pharmacy technician license (state specific if state required). If licensed, license must be active and unrestricted in state of practice. - Health care industry 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: $21.65 - $28.82 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
$21.7-28.8 hourly 36d ago
Representative, Pharmacy
Molina Healthcare Inc. 4.4
Ohio jobs
Provides customer service support for inbound/outbound 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 Available:12:30-9 PM MST Essential Job Duties * Handles and records inbound/outbound pharmacy calls from members, providers and pharmacies in accordance with departmental policies, state regulations, National Committee of Quality Assurance (NCQA) guidelines, and Centers for Medicare and Medicaid Services (CMS) standards. * Provides coordination and processing of pharmacy prior authorization requests and/or appeals. * Explains point-of-sale claims adjudication, state, NCQA and CMS policies/guidelines, and any other necessary information to providers, members and pharmacies. * Assists with clerical tasks and other day-to-day pharmacy call center operations as delegated. * Effectively communicates plan benefit information, including but not limited to: formulary information, copay amounts, pharmacy location services and prior authorization outcomes. * Assists members and providers with initiating verbal and written coverage determinations and appeals. * Records calls accurately within the pharmacy call tracking system. * Maintains established pharmacy call quality and quantity standards. * Interacts with appropriate primary care providers to ensure member registry is current and accurate. * Supports pharmacists with completion of comprehensive medication reviews (CMRs)through pre-work up to case preparation. * Proactively identifies ways to improve pharmacy call center member relations. Required Qualifications * At least 1 year related experience, including call center or customer service experience, or equivalent combination of relevant education and experience. * Excellent customer service skills. * Ability to work independently when assigned special projects, such as pill box requests, case management referrals, over the counter (OTC) requests, etc. * Ability to multi-task applications while speaking with members. * 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 (including Excel), and applicable software program(s) proficiency. Preferred Qualifications * Certified Pharmacy Technician (CPhT) and/or state pharmacy technician license (state specific if state required). If licensed, license must be active and unrestricted in state of practice. * Health care industry 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: $21.65 - $28.82 / HOURLY * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
$21.7-28.8 hourly 37d ago
Representative, Pharmacy
Molina Healthcare 4.4
Ohio jobs
Provides customer service support for inbound/outbound 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 Available:** **12:30-9 PM MST** **Essential Job Duties** - Handles and records inbound/outbound pharmacy calls from members, providers and pharmacies in accordance with departmental policies, state regulations, National Committee of Quality Assurance (NCQA) guidelines, and Centers for Medicare and Medicaid Services (CMS) standards. - Provides coordination and processing of pharmacy prior authorization requests and/or appeals. - Explains point-of-sale claims adjudication, state, NCQA and CMS policies/guidelines, and any other necessary information to providers, members and pharmacies. - Assists with clerical tasks and other day-to-day pharmacy call center operations as delegated. - Effectively communicates plan benefit information, including but not limited to: formulary information, copay amounts, pharmacy location services and prior authorization outcomes. - Assists members and providers with initiating verbal and written coverage determinations and appeals. - Records calls accurately within the pharmacy call tracking system. - Maintains established pharmacy call quality and quantity standards. - Interacts with appropriate primary care providers to ensure member registry is current and accurate. - Supports pharmacists with completion of comprehensive medication reviews (CMRs)through pre-work up to case preparation. - Proactively identifies ways to improve pharmacy call center member relations. **Required Qualifications** - At least 1 year related experience, including call center or customer service experience, or equivalent combination of relevant education and experience. - Excellent customer service skills. - Ability to work independently when assigned special projects, such as pill box requests, case management referrals, over the counter (OTC) requests, etc. - Ability to multi-task applications while speaking with members. - 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 (including Excel), and applicable software program(s) proficiency. **Preferred Qualifications** - Certified Pharmacy Technician (CPhT) and/or state pharmacy technician license (state specific if state required). If licensed, license must be active and unrestricted in state of practice. - Health care industry 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: $21.65 - $28.82 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
$21.7-28.8 hourly 36d ago
Representative, Dental Provider Services
Molina Healthcare Inc. 4.4
Cleveland, OH jobs
is February. Molina Health Plan Provider Network Management and Operations jobs are responsible for network development, network adequacy and provider training and education, in alignment with Molina Healthcare's overall mission, core values, and strategic plan and in compliance with all relevant federal, state and local regulations. Provider Services staff are the primary point of contact between Molina Healthcare and contracted provider network. They are responsible for the provider training, network management and ensuring knowledge of and compliance with Molina healthcare policies and procedures while achieving the highest level of customer service. KNOWLEDGE/SKILLS/ABILITIES This role serves as the primary point of contact between Molina Health plan and the Provider community that serves Molina members. It's an external-facing, field-based position requiring a high degree of job knowledge, communication, and organizational skills to successfully engage high volume, high visibility providers (including senior leaders and physicians) to ensure provider satisfaction, education on key Molina initiatives, and improved coordination and partnership. * Under minimal direction, works directly with the Plan's external providers to educate, advocate, and engage as valuable partners, ensuring knowledge of and compliance with Molina policies and procedures while achieving the highest level of customer service. * Conducts regular provider site visits within assigned region/service area. Determines own daily or weekly schedule, as needed to meet or exceed the Plan's monthly site visit goals. A key responsibility of the Representative during these visits is to proactively engage with the provider and staff to determine, for example, non-compliance with Molina policies/procedures or CMS guidelines/regulations, or to assess the non-clinical quality of customer service provided to Molina members. * Provides on-the-spot training and education as needed, which may include counseling providers diplomatically, while retaining a positive working relationship. * Independently troubleshoots problems as they arise, making an assessment when escalation to a Senior Representative, Supervisor, or another Molina department is needed. Takes initiative in preventing and resolving issues between the provider and the Plan whenever possible. The types of questions, issues or problems that may emerge during visits are unpredictable and may range from simple to very complex or sensitive matters. * Initiates, coordinates, and participates in problem-solving meetings between the provider and Molina stakeholders, including senior leadership and physicians. Such meetings would occur to discuss and resolve issues related to utilization management, pharmacy, quality of care, and correct coding, for example. * Independently delivers training and presentations to assigned providers and their staff, answering questions that come up on behalf of the Health plan. May also deliver training and presentations to larger groups, such as leaders and management of provider offices (including large multispecialty groups or health systems, executive level decision makers, Association meetings, and JOC's). * Performs an integral role in network management, by monitoring and enforcing company policies and procedures, while increasing provider effectiveness by educating and promoting participation in various Molina initiatives. Examples of such initiatives include administrative cost effectiveness, member satisfaction - CAHPS, regulatory-related, Molina Quality programs, and taking advantage of electronic solutions (EDI, EFT, EMR, Provider Portal, Provider Website, etc.). * Trains other Provider Services Representatives as appropriate. * Role requires 80%+ same-day or overnight travel. (Extent of overnight travel will depend on the specific Health Plan and its service area.). JOB QUALIFICATIONS Required Education Bachelor's Degree or equivalent provider contract, network development and management, or project management experience in a managed healthcare setting. Required Experience * 2 - 3 years customer service, provider service, or claims experience in a managed care setting. * Working familiarity with various managed healthcare provider compensation methodologies, primarily across Medicaid and Medicare lines of business, including but not limited to, fee-for service, capitation, and various forms of risk, ASO, etc. Preferred Education Bachelor's Degree. Preferred Experience * 5 years' experience in managed healthcare administration and/or Provider Services. * 5 years' experience in provider contract negotiations in a managed healthcare setting ideally in negotiating different provider contract types, i.e., physician, group and hospital contracting, etc. 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. Pay Range: $21.65 - $46.42 / HOURLY * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
$32k-37k yearly est. 30d ago
Representative, Dental Provider Services
Molina Healthcare Inc. 4.4
Akron, OH jobs
is February. Molina Health Plan Provider Network Management and Operations jobs are responsible for network development, network adequacy and provider training and education, in alignment with Molina Healthcare's overall mission, core values, and strategic plan and in compliance with all relevant federal, state and local regulations. Provider Services staff are the primary point of contact between Molina Healthcare and contracted provider network. They are responsible for the provider training, network management and ensuring knowledge of and compliance with Molina healthcare policies and procedures while achieving the highest level of customer service. KNOWLEDGE/SKILLS/ABILITIES This role serves as the primary point of contact between Molina Health plan and the Provider community that serves Molina members. It's an external-facing, field-based position requiring a high degree of job knowledge, communication, and organizational skills to successfully engage high volume, high visibility providers (including senior leaders and physicians) to ensure provider satisfaction, education on key Molina initiatives, and improved coordination and partnership. * Under minimal direction, works directly with the Plan's external providers to educate, advocate, and engage as valuable partners, ensuring knowledge of and compliance with Molina policies and procedures while achieving the highest level of customer service. * Conducts regular provider site visits within assigned region/service area. Determines own daily or weekly schedule, as needed to meet or exceed the Plan's monthly site visit goals. A key responsibility of the Representative during these visits is to proactively engage with the provider and staff to determine, for example, non-compliance with Molina policies/procedures or CMS guidelines/regulations, or to assess the non-clinical quality of customer service provided to Molina members. * Provides on-the-spot training and education as needed, which may include counseling providers diplomatically, while retaining a positive working relationship. * Independently troubleshoots problems as they arise, making an assessment when escalation to a Senior Representative, Supervisor, or another Molina department is needed. Takes initiative in preventing and resolving issues between the provider and the Plan whenever possible. The types of questions, issues or problems that may emerge during visits are unpredictable and may range from simple to very complex or sensitive matters. * Initiates, coordinates, and participates in problem-solving meetings between the provider and Molina stakeholders, including senior leadership and physicians. Such meetings would occur to discuss and resolve issues related to utilization management, pharmacy, quality of care, and correct coding, for example. * Independently delivers training and presentations to assigned providers and their staff, answering questions that come up on behalf of the Health plan. May also deliver training and presentations to larger groups, such as leaders and management of provider offices (including large multispecialty groups or health systems, executive level decision makers, Association meetings, and JOC's). * Performs an integral role in network management, by monitoring and enforcing company policies and procedures, while increasing provider effectiveness by educating and promoting participation in various Molina initiatives. Examples of such initiatives include administrative cost effectiveness, member satisfaction - CAHPS, regulatory-related, Molina Quality programs, and taking advantage of electronic solutions (EDI, EFT, EMR, Provider Portal, Provider Website, etc.). * Trains other Provider Services Representatives as appropriate. * Role requires 80%+ same-day or overnight travel. (Extent of overnight travel will depend on the specific Health Plan and its service area.). JOB QUALIFICATIONS Required Education Bachelor's Degree or equivalent provider contract, network development and management, or project management experience in a managed healthcare setting. Required Experience * 2 - 3 years customer service, provider service, or claims experience in a managed care setting. * Working familiarity with various managed healthcare provider compensation methodologies, primarily across Medicaid and Medicare lines of business, including but not limited to, fee-for service, capitation, and various forms of risk, ASO, etc. Preferred Education Bachelor's Degree. Preferred Experience * 5 years' experience in managed healthcare administration and/or Provider Services. * 5 years' experience in provider contract negotiations in a managed healthcare setting ideally in negotiating different provider contract types, i.e., physician, group and hospital contracting, etc. 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. Pay Range: $21.65 - $46.42 / HOURLY * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
$32k-37k yearly est. 30d ago
Representative, Dental Provider Services
Molina Healthcare Inc. 4.4
Cincinnati, OH jobs
is February. Molina Health Plan Provider Network Management and Operations jobs are responsible for network development, network adequacy and provider training and education, in alignment with Molina Healthcare's overall mission, core values, and strategic plan and in compliance with all relevant federal, state and local regulations. Provider Services staff are the primary point of contact between Molina Healthcare and contracted provider network. They are responsible for the provider training, network management and ensuring knowledge of and compliance with Molina healthcare policies and procedures while achieving the highest level of customer service. KNOWLEDGE/SKILLS/ABILITIES This role serves as the primary point of contact between Molina Health plan and the Provider community that serves Molina members. It's an external-facing, field-based position requiring a high degree of job knowledge, communication, and organizational skills to successfully engage high volume, high visibility providers (including senior leaders and physicians) to ensure provider satisfaction, education on key Molina initiatives, and improved coordination and partnership. * Under minimal direction, works directly with the Plan's external providers to educate, advocate, and engage as valuable partners, ensuring knowledge of and compliance with Molina policies and procedures while achieving the highest level of customer service. * Conducts regular provider site visits within assigned region/service area. Determines own daily or weekly schedule, as needed to meet or exceed the Plan's monthly site visit goals. A key responsibility of the Representative during these visits is to proactively engage with the provider and staff to determine, for example, non-compliance with Molina policies/procedures or CMS guidelines/regulations, or to assess the non-clinical quality of customer service provided to Molina members. * Provides on-the-spot training and education as needed, which may include counseling providers diplomatically, while retaining a positive working relationship. * Independently troubleshoots problems as they arise, making an assessment when escalation to a Senior Representative, Supervisor, or another Molina department is needed. Takes initiative in preventing and resolving issues between the provider and the Plan whenever possible. The types of questions, issues or problems that may emerge during visits are unpredictable and may range from simple to very complex or sensitive matters. * Initiates, coordinates, and participates in problem-solving meetings between the provider and Molina stakeholders, including senior leadership and physicians. Such meetings would occur to discuss and resolve issues related to utilization management, pharmacy, quality of care, and correct coding, for example. * Independently delivers training and presentations to assigned providers and their staff, answering questions that come up on behalf of the Health plan. May also deliver training and presentations to larger groups, such as leaders and management of provider offices (including large multispecialty groups or health systems, executive level decision makers, Association meetings, and JOC's). * Performs an integral role in network management, by monitoring and enforcing company policies and procedures, while increasing provider effectiveness by educating and promoting participation in various Molina initiatives. Examples of such initiatives include administrative cost effectiveness, member satisfaction - CAHPS, regulatory-related, Molina Quality programs, and taking advantage of electronic solutions (EDI, EFT, EMR, Provider Portal, Provider Website, etc.). * Trains other Provider Services Representatives as appropriate. * Role requires 80%+ same-day or overnight travel. (Extent of overnight travel will depend on the specific Health Plan and its service area.). JOB QUALIFICATIONS Required Education Bachelor's Degree or equivalent provider contract, network development and management, or project management experience in a managed healthcare setting. Required Experience * 2 - 3 years customer service, provider service, or claims experience in a managed care setting. * Working familiarity with various managed healthcare provider compensation methodologies, primarily across Medicaid and Medicare lines of business, including but not limited to, fee-for service, capitation, and various forms of risk, ASO, etc. Preferred Education Bachelor's Degree. Preferred Experience * 5 years' experience in managed healthcare administration and/or Provider Services. * 5 years' experience in provider contract negotiations in a managed healthcare setting ideally in negotiating different provider contract types, i.e., physician, group and hospital contracting, etc. 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. Pay Range: $21.65 - $46.42 / HOURLY * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
$32k-37k yearly est. 30d ago
Representative, Dental Provider Services
Molina Healthcare Inc. 4.4
Ohio jobs
is February. Molina Health Plan Provider Network Management and Operations jobs are responsible for network development, network adequacy and provider training and education, in alignment with Molina Healthcare's overall mission, core values, and strategic plan and in compliance with all relevant federal, state and local regulations. Provider Services staff are the primary point of contact between Molina Healthcare and contracted provider network. They are responsible for the provider training, network management and ensuring knowledge of and compliance with Molina healthcare policies and procedures while achieving the highest level of customer service. KNOWLEDGE/SKILLS/ABILITIES This role serves as the primary point of contact between Molina Health plan and the Provider community that serves Molina members. It's an external-facing, field-based position requiring a high degree of job knowledge, communication, and organizational skills to successfully engage high volume, high visibility providers (including senior leaders and physicians) to ensure provider satisfaction, education on key Molina initiatives, and improved coordination and partnership. * Under minimal direction, works directly with the Plan's external providers to educate, advocate, and engage as valuable partners, ensuring knowledge of and compliance with Molina policies and procedures while achieving the highest level of customer service. * Conducts regular provider site visits within assigned region/service area. Determines own daily or weekly schedule, as needed to meet or exceed the Plan's monthly site visit goals. A key responsibility of the Representative during these visits is to proactively engage with the provider and staff to determine, for example, non-compliance with Molina policies/procedures or CMS guidelines/regulations, or to assess the non-clinical quality of customer service provided to Molina members. * Provides on-the-spot training and education as needed, which may include counseling providers diplomatically, while retaining a positive working relationship. * Independently troubleshoots problems as they arise, making an assessment when escalation to a Senior Representative, Supervisor, or another Molina department is needed. Takes initiative in preventing and resolving issues between the provider and the Plan whenever possible. The types of questions, issues or problems that may emerge during visits are unpredictable and may range from simple to very complex or sensitive matters. * Initiates, coordinates, and participates in problem-solving meetings between the provider and Molina stakeholders, including senior leadership and physicians. Such meetings would occur to discuss and resolve issues related to utilization management, pharmacy, quality of care, and correct coding, for example. * Independently delivers training and presentations to assigned providers and their staff, answering questions that come up on behalf of the Health plan. May also deliver training and presentations to larger groups, such as leaders and management of provider offices (including large multispecialty groups or health systems, executive level decision makers, Association meetings, and JOC's). * Performs an integral role in network management, by monitoring and enforcing company policies and procedures, while increasing provider effectiveness by educating and promoting participation in various Molina initiatives. Examples of such initiatives include administrative cost effectiveness, member satisfaction - CAHPS, regulatory-related, Molina Quality programs, and taking advantage of electronic solutions (EDI, EFT, EMR, Provider Portal, Provider Website, etc.). * Trains other Provider Services Representatives as appropriate. * Role requires 80%+ same-day or overnight travel. (Extent of overnight travel will depend on the specific Health Plan and its service area.). JOB QUALIFICATIONS Required Education Bachelor's Degree or equivalent provider contract, network development and management, or project management experience in a managed healthcare setting. Required Experience * 2 - 3 years customer service, provider service, or claims experience in a managed care setting. * Working familiarity with various managed healthcare provider compensation methodologies, primarily across Medicaid and Medicare lines of business, including but not limited to, fee-for service, capitation, and various forms of risk, ASO, etc. Preferred Education Bachelor's Degree. Preferred Experience * 5 years' experience in managed healthcare administration and/or Provider Services. * 5 years' experience in provider contract negotiations in a managed healthcare setting ideally in negotiating different provider contract types, i.e., physician, group and hospital contracting, etc. 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. Pay Range: $21.65 - $46.42 / HOURLY * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
$32k-37k yearly est. 30d ago