Pharmacy Specialist I

Job not on LinkedIn

🕒 6 days ago

🏖️ New Jersey – Remote

🏖️ New Jersey – Remote

💵 $44.6k - $59.7k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

💊 Pharmacist

🚫👨‍🎓 No degree required

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Horizon Connect @ Wall BCBSNJ

WebsiteLinkedInAll Job Openings

2 - 10 employees

⚕️ Healthcare Insurance

🏥 Healthcare

Healthcare Insurance • Healthcare

Horizon Connect @ Wall BCBSNJ is a LinkedIn presence or local program/office associated with Horizon Blue Cross Blue Shield of New Jersey (BCBSNJ). Based on the name and context, it appears to be connected to Horizon BCBSNJ’s health insurance operations and local outreach or member/provider engagement in the Wall, NJ area. Publicly available information provided is limited and mostly LinkedIn site chrome rather than a company profile, so this description is conservative and based on the affiliation indicated by the name.

📋 Description

• Responsible for all telephonic interaction with members, physician office staff, pharmacies and internal stakeholders for Pharmacy eligibility, coverage determination, and/or claim issues. • Engagement with physicians & pharmacists to conduct effective interventions through clinical therapeutic interchange to facilitate formulary compliance, optimize generic dispensing, and consistency with the current plan design. • Capture accurate and comprehensive clinical information for Prior Authorization requests from physicians and/or medical office staff to allow for clinical review and medical necessity determination. • Responsible for satisfying all departmental customer service quality metrics while ensuring that all DMAHS and DOBI required regulatory turnaround times are consistently satisfied. • Process complaints, appeals, grievances, executive inquiries and compliance related issues. • Responsible for identifying via interactions with members and providers, instances of potential fraud, waste, and abuse and resulting internal referrals that are necessary. • Provide recommendations to increase efficiency, accuracy and productivity in the department. • Process ad hoc request for information or reports from stakeholders. • Accountable for independent and group learnings to ensure understanding of pharmacy services procedures and workflows. • Assist in the day-to-day business functions of the pharmacy department as well as the Medication Therapy Management program. • Provide support to various clinical programs within the pharmacy department.

🎯 Requirements

• High School Diploma/GED required • Requires minimum of two (2) years experience as a Pharmacy technician • Prefers minimum of two (2) years experience in third party prescription program claim adjudication. • Requires prior customer service/service quality initiative experience. • Requires National Pharmacy Technician Certification (PTCB or ExCPT). • In lieu of the Pharmacy Tech Certification, a minimum of 5 years’ experience as a retail pharmacy technician or relevant pharmacy experience in managed care or a PBM (Pharmacy Benefit Management) organization required. • Requires knowledge of popular brand and generic drug names. • Requires knowledge of third party prescription program claim adjudication. • Requires working knowledge of managed care principles. • Requires knowledge of common medical terminology. • Requires understanding of National Drug Code (NDC). • Requires knowledge of State of New Jersey Board of Pharmacy regulations and State Federal controlled substances regulation.

🏖️ Benefits

• Comprehensive health benefits (Medical/Dental/Vision) • Retirement Plans • Generous PTO • Incentive Plans • Wellness Programs • Paid Volunteer Time Off • Tuition Reimbursement