Pharmacy Specialist I

Job not on LinkedIn

🔥 6 minutes ago

🦌 Connecticut, New Jersey, +2 more states – Remote

🦌 Connecticut – Remote 🏖️ New Jersey – Remote 🗽 New York – Remote 🔔 Pennsylvania – Remote

💵 $44.6k - $59.7k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

💊 Pharmacist

🚫👨‍🎓 No degree required

👻 Ghost score 15%

What it means: the chance that no one is really hiring for this job.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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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

• Receive verbal and written prior authorization requests from pharmacists, physicians, and/or members • Support and assist in coordinating Pharmacy Services benefits, including claim utilization analysis, prescription plan design, ad-hoc reporting, correspondence, and special projects • Process prior authorization requests received via fax or prior authorization help line by evaluating medical necessity and appropriateness for specific drugs based on clinical criteria • Handle telephonic interactions with members, physician office staff, pharmacies, and internal stakeholders regarding Pharmacy eligibility, coverage determination, and claim issues • Engage physicians and pharmacists in clinical therapeutic interchange to facilitate formulary compliance, optimize generic dispensing, and maintain consistency with current plan design • Capture accurate and comprehensive clinical information for prior authorization requests to support clinical review and medical necessity determinations • Satisfy departmental customer service quality metrics and DMAHS/DOBI regulatory turnaround times • Process complaints, appeals, grievances, executive inquiries, and compliance-related issues • Identify potential fraud, waste, and abuse and make necessary internal referrals • Provide recommendations to increase department efficiency, accuracy, and productivity • Process ad hoc information or report requests from stakeholders • Complete independent and group learning to understand pharmacy services procedures and workflows • Assist with day-to-day pharmacy department functions and the Medication Therapy Management program • Support 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 • Requires the ability to utilize a personal computer and applicable software • Must have effective verbal and written communication skills and demonstrate the ability to work well within a team • Demonstrated ability to deliver highly technical information to less technical individuals • Must demonstrate professional and ethical business practices, adherence to company standards, and a commitment to personal and professional development • Proven time management skills; ability to manage multiple priorities, deliver timely and accurate work products with a customer service focus, and respond with a sense of urgency • Demonstrated ability to work in a production focused environment • Proven ability to exercise sound judgment and strong problem solving skills • Proven ability to ask probing questions and obtain thorough and relevant information

🏖️ Benefits

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

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