Pharmacy Specialist I

Job not on LinkedIn

🕒 July 6

🏖️ New Jersey – Remote

🏖️ New Jersey – Remote

💵 $44.6k - $59.7k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

💊 Pharmacist

🚫👨‍🎓 No degree required

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NJM Insurance Group

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1913

Insurance

NJM Insurance Group is a well-established insurance provider offering a range of personal and commercial insurance products. Their services include auto, homeowners, renters, condo, commercial auto, and business insurance, with a focus on exceptional customer satisfaction and claims experience. NJM is recognized for its outstanding auto claims experience by J. D. Power and is committed to serving customers in states like Connecticut, Maryland, New Jersey, Ohio, and Pennsylvania. The company prides itself on being straightforward and customer-focused, without jingles or mascots, offering trusted insurance solutions and multiple discount opportunities for various policies.

📋 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 • Minimum of two (2) years experience as a Pharmacy technician • Minimum of two (2) years experience in third party prescription program claim adjudication preferred • Requires prior customer service/service quality initiative experience • National Pharmacy Technician Certification (PTCB or ExCPT) required • 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