Molina Medicaid Solutions - DHHR

Bridging the Rivers ofChange TogetherWest Virginia MMIS Re-ProcurementSolicitation: MED13006ROLE RESPONSIBILITIES SKILL SET Documents defects from test caseexecution Thorough knowledge of MedicaidcomponentsPortalConfigurationAnalystPOS ClinicalLeadPOS HelpDesk RxClaimsClinicalPOS TechnicalLeadPOS TechnicalTeamResourcesProviderEnrollmentLeadTracks defects and code drops related toassigned solution component; helps ensuretheir completion and incorporation into allrelated documentationEnsures all standards are applied to portaldesignsGain approval for all changesDocument changes to portalSupport clinical programs for thepharmacy POS, such as criteriadevelopment for automatic priorauthorization and drug utilization reviewparametersResponds to pharmacy POS questionsAssists pharmacy providers with questionsregarding BMS policy for pharmacyservicesProvides resolution to pharmacy point ofsale claims that, based on BMS policy andclinical needs, require an overrideProvides data layouts/responds to questionsregarding pharmacy point of sale claimssubmissionSupports technical aspects of the pharmacyPOS including but not limited to theautomatic prior authorization program,clinical Web portal, drug utilization reviewprogram, and othersSuggests improvements to functionalityMonitors team work assignmentsLeads POS Technical TeamSupport technical aspects of the PharmacyPOS including but not limited to theautomatic prior authorization program,clinical Web portal, drug utilization reviewprogram, and othersSupervises and provides direct oversight ofthe activities of the provider enrollmentunitAssists in the development of internaldesktop processes, policies, and proceduresin conjunction with the managerMaintains appropriate call center reportingstatistics and quality improvementpracticesResearches, reports, and analyzesenrollment data including functions of theExcellent interpersonal and verbal andwritten communication skillsBachelor’s degree or equivalentexperience in Web designThree years of Web Design experienceHealth care experience preferredPreference given to a registeredpharmacist with two years of experienceHigh School Diploma or GEDWorking knowledge of West VirginiaMMISKnowledge of BMS pharmacy policiesFive years of Medicaid experience withthree of those years specific to WestVirginia MedicaidBA/BS degree preferred in computerscience, information systems, or relatedfieldFive years of directly relevant experienceBA/BS degree preferred in computerscience, information systems, or relatedfieldThree years of directly relevant experienceBachelor’s Degree or equivalentexperienceThree to five years of leadership/supervisory experience in a call centeroperations environmentFour plus years experience in claimsand/or benefits interpretation and providernetworking14.4-31