Pharmacy Specialist I
Overview
Horizon Blue Cross Blue Shield of New Jersey seeks a Pharmacy Specialist I to lead prior authorization processes and coordinate pharmacy services. This role drives member satisfaction and operational excellence across a large network.
What You'll Do11
- 1Handle telephonic interactions regarding eligibility and coverage
- 2Engage physicians and pharmacists for therapeutic interventions
- 3Capture clinical data for prior authorization requests
- 4Ensure compliance with regulatory standards and timelines
- 5Resolve complaints and process appeals
- 6Identify fraud and recommend efficiency improvements
- 7Support Medication Therapy Management initiatives
- 8Assist in daily pharmacy operations and MTM programs
- 9Provide training and support to clinical teams
- 10Maintain accurate records and documentation
- 11Collaborate with cross-functional stakeholders
Requirements10
- 1High School Diploma or GED
- 2Minimum two years pharmacy technician experience
- 3National Pharmacy Technician Certification or equivalent experience
- 4Knowledge of NDC and drug nomenclature
- 5Familiarity with managed care and PBM principles
- 6Proficiency in third-party prescription adjudication
- 7Understanding of NJ Board of Pharmacy regulations
- 8Ability to work in production-focused environment
- 9Strong problem-solving and judgment skills
- 10Effective communication and teamwork abilities
Salary Insight
$45 - $60k per year
Location
Required Skills
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