Pharmacy Specialist I

Job not on LinkedIn

🔥 0 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

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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 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 using clinical criteria • Handle telephonic interactions with members, physician office staff, pharmacies, and internal stakeholders regarding eligibility, coverage determinations, and claim issues • Engage physicians and pharmacists in clinical therapeutic interchange interventions to facilitate formulary compliance and optimize generic dispensing • Capture accurate and comprehensive clinical information for prior authorization requests • 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 departmental efficiency, accuracy, and productivity • Process ad-hoc information or report requests from stakeholders • Participate in independent and group learning on pharmacy services procedures and workflows • Assist with day-to-day pharmacy department functions and the Medication Therapy Management program • Support clinical programs within the pharmacy department • Meet departmental customer service quality metrics and regulatory turnaround times

🎯 Requirements

• High School Diploma/GED required • Minimum of two (2) years’ experience as a Pharmacy technician • Prior customer service/service quality initiative experience required • National Pharmacy Technician Certification (PTCB or ExCPT) required • In lieu of Pharmacy Technician Certification, minimum of 5 years’ experience as a retail pharmacy technician or relevant pharmacy experience in managed care or a PBM organization required • Knowledge of popular brand and generic drug names • Knowledge of third-party prescription program claim adjudication • Working knowledge of managed care principles • Knowledge of common medical terminology • Understanding of National Drug Code (NDC) • Knowledge of State of New Jersey Board of Pharmacy regulations and state/federal controlled substances regulations • Ability to use a personal computer and applicable software • Effective verbal and written communication skills • Ability to deliver highly technical information to less technical individuals • Professional and ethical business practices and adherence to company standards • Time management skills and ability to manage multiple priorities • Ability to deliver timely and accurate work products with a customer service focus • Ability to work in a production-focused environment • Sound judgment and strong problem-solving skills • Ability to ask probing questions and obtain thorough, relevant information

🏖️ Benefits

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