Qureos Mentor

Molina Healthcare

<div>JOB DESCRIPTION Job Summary

Provides entry level support for actuarial function activities including extracting, analyzing, and synthesizing data from various sources to identify risks. Estimates liabilities, establishes premium rates, and supports financial analysis and reporting. 


Essential Job Duties
<ul><li>Supports the development of incurred but not reported (IBNR) estimates and rate adequacy studies, and documents assumptions.</li><li>Analyzes results to identify early signs of trends or other issues related to medical care costs.</li><li>Performs actuarial studies related to medical care costs and trends.</li><li>Generates and distributes routine reports to support IBNR calculations, pricing and financial reporting.</li><li>Extracts and compiles information from various systems to support executive decision-making.</li><li>Supports the development of reports and analysis for senior leadership, and effectively communicates results.</li></ul> 
Required Qualifications
<ul><li>Up to 1 year of actuarial experience, or equivalent combination of relevant education and experience.</li><li>At least 1 passing Society of Actuaries (SOA) exam.</li><li>Bachelor&rsquo;s degree in actuarial, mathematics, statistics, economics or related field.</li><li>Advanced understanding of statistics/predictive analytics.</li><li>Demonstrated problem-solving skills.</li><li>Strong critical-thinking and attention to detail.</li><li>Ability to effectively collaborate with technical and non-technical stakeholders.</li><li>Strong time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines.</li><li>Effective verbal and written communication skills.</li><li>Proficient in Microsoft Office suite products, including key skills in Excel (VLOOKUPs and pivot tables), and applicable software program(s) proficiency.</li></ul> 
Preferred Qualifications
<ul><li>Actuarial internship.</li></ul> 

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</div>

Associate Analyst, Actuarial - REMOTE

Molina Healthcare is hiring for a Pharmacist in our UM/Prior Authorization department. Candidates must be licensed to practice in the state of Florida or be able to obtain Florida licensure within 90 days of starting. This position is remote and can be worked from a variety of locations within the US. Shift times can be either 8 or 10 hour shifts between the times of 7a and 10p EST with rotating weekends depending on business needs. Molina Pharmacy Services/Management staff work to ensure that Molina members have access to all medically necessary prescription drugs and those drugs are used in a cost-effective, safe manner. These jobs are responsible for creating, operating, and monitoring Molina Health Plan's pharmacy benefit programs in accordance with all federal and state laws. Jobs in this family include those involved in formulary management (such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and pharmacy costs management), clinical pharmacy services (such as, therapeutic drug monitoring, drug regimen review, patient education, and medical staff interaction), and oversight (establishing and measuring performance metrics regarding patient outcomes, medications safety and medication use policies). KNOWLEDGE/SKILLS/ABILITIES The Pharmacist, UM will be responsible for reviewing coverage determinations and appeals in a timely, compliant, and accurate manner. The Pharmacist, UM will also be responsible for serving as a formulary and drug information resource, assisting technicians and other departments with questions regarding drug coverage. <ul><li>Acts as a liaison between Molina and its customers (members, providers and pharmacies) with respect to the pharmacy benefit.</li><li>Serves as the formulary expert.</li><li>Ensures Molina is compliant with the coverage determination and appeals process.</li><li>Contributes to projects aimed at improving Star ratings, HEDIS, CAHPS, and other quality metrics.</li><li>Assists call center pharmacy technicians with clinical questions and phone calls from prescribers, pharmacies and/or members.</li><li>Develops, implements and maintains pharmacy cost control and quality initiatives under the direction of leadership.</li><li>Monitors drug utilization and assists leadership team in understanding quality and cost control issues related to pharmacy.</li><li>Works in tandem with Molina Medical Directors to ensure accurate coverage determination decisions.</li><li>Works with leadership on developing annual training sessions for applicable staff regarding the pharmacy benefit changes for the upcoming year.</li><li>Works with the Case Management department as part of a member-centered interdisciplinary care team.</li><li>Works with the PBM to manage formulary changes and update marketing on any changes needed on the web or print versions of the formulary.</li><li>Performs outreach to patients and physicians as part of quality and/or cost control initiatives.</li><li>Provides leadership for the pharmacy call center team as delegated by the Manager.</li><li>Identifies and implements programs to improve clinical outcomes stemming from medication selection, utilization, and adherence.</li></ul>JOB QUALIFICATIONS Required Education <ul><li>Doctor of Pharmacy or bachelor&rsquo;s degree in pharmacy with equivalent experience.</li><li>Continuing education required to maintain an active pharmacist license.</li></ul>Required Experience: 1 - 2 years post-graduate experience. Required License, Certification, Association: Active and unrestricted State Pharmacy License for workplace and plan location. Preferred Experience <ul><li>Medicare Part D or Medicaid experience.</li><li>Managed care experience.</li></ul>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. #PJPharm2 #LI-AC1 Pay Range: $80,412 - $156,803.45 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Pharmacist, Prior Auth/Utilization Management, Remote

Molina Healthcare is hiring for remote Certified Pharmacy Technicians. These roles will be in our Prior Authorization department. You will review prior auth requests that are submitted. Schedules for these role will vary between 7am to 10pm EST. Qualified candidates must have either PTCB certification or Pharmacy Tech State license. High preference for those who are self-starters and go-getters. Must have above average computer skills along with a high level of communication skills both written and verbal. As a Pharmacy Tech here at Molina, you will provide support for pharmacy technician activities. You will also contribute to overarching pharmacy strategy for optimization of medication related health care outcomes, and quality cost-effective member care. Essential Job Duties <ul><li>Performs initial receipt and review of non-formulary or prior authorization requests against pharmacy plan approved criteria; requests additional information from providers as needed to properly evaluate requests.</li><li>Accurately enters approvals or denials of requests.</li><li>Facilitates prior authorization requests within established pharmacy policies and procedures.</li><li>Participates in the development/administration of pharmacy programs designed to enhance the utilization of targeted drugs and identification of cost-saving pharmacy practices.</li><li>Identifies and reports pharmacy departmental operational issues and resource needs to appropriate leadership.</li><li>Assists Molina member services, pharmacies, and health plan providers in resolving member prescription claims, prior authorizations, and pharmacy service access issues.</li><li>Articulates pharmacy management policies and procedures to pharmacy/health plan providers, Molina staff and others as needed.</li></ul>Required Qualifications <ul><li>At least 2 years pharmacy technician experience, or equivalent combination of relevant education and experience.</li><li>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.</li><li>Ability to abide by Molina policies.</li><li>Ability to maintain attendance to support required quality and quantity of work.</li><li>Ability to maintain confidentiality and comply with the Health Insurance Portability and Accountability Act (HIPAA).</li><li>Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers.</li><li>Excellent verbal and written communication skills.</li><li>Microsoft Office suite (including Excel), and applicable software program(s) proficiency.</li></ul>#PJPharm3 #LI-AC1 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: $12.19 - $26.42 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Pharmacy Technician CPhT Prior Auth (Remote)

Join Molina Healthcare and explore 3   exciting career opportunities. They're hiring for various roles with options for remote or on-site work. Apply today and become part of their innovative team.

Molina Healthcare

About Company

Associate Analyst, Actuarial - REMOTE

Pharmacist, Prior Auth/Utilization Management, Remote

Pharmacy Technician CPhT Prior Auth (Remote)