Student Veterans of America Jobs

Welcome to SVA’s jobs portal, your one-stop shop for finding the most up to date source of employment opportunities. We have partnered with the National Labor Exchange to provide you this information. You may be looking for part-time employment to supplement your income while you are in school. You might be looking for an internship to add experience to your resume. And you may be completing your training ready to start a new career. This site has all of those types of jobs.

Here are a few things you should know:
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  • Jobs on this site are original and unduplicated and come from three sources: the Federal government, state workforce agency job banks, and corporate career websites. All jobs are vetted to ensure there are no scams, training schemes, or phishing.
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  • The newest jobs are listed first, so use the search features to match your interests. You can look for jobs in a specific geographical location, by title or keyword, or you can use the military crosswalk. You may want to do something different from your military career, but you undoubtedly have skills from that occupation that match to a civilian job.
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Job Information

Molina Healthcare Customer Service Representative, Medicare Pharmacy (Remote) in Lexington, Kentucky

JOB DESCRIPTION

Job Summary

Molina Pharmacy Services/Management staff work to ensure that Molina members, providers, and pharmacies 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

  • Handles and records inbound pharmacy calls from members, providers, and pharmacies to meet departmental, State regulations, NCQA guidelines, and CMS standards.

  • Provides coordination and processing of pharmacy prior authorization requests and/or appeals.

  • Explains Point of Sale claims adjudication, state, NCQA, and CMS policy/guidelines, and any other necessary information to providers, members, and pharmacies.

  • Assists with clerical services/tasks and other day-to-day 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 member and providers with initiating oral and written coverage determinations and appeals.

  • Records calls accurately in call tracking system.

  • Maintains specific quality and quantity standards.

JOB QUALIFICATIONS

Required Education

High School Diploma or GED equivalent

Required Experience

1-3 years of call center or customer service experience

Preferred Education

Associate degree

Preferred Experience

  • 3-5 years; healthcare industry experience preferred

  • National pharmacy technician certification

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: $11.09 - $24.02 / HOURLY

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

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