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Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware
Job Summary :
This position is responsible for receiving verbal and written request for prior authorization from pharmacists, physicians and / or patients and is responsible for supporting and assisting in the coordination of Pharmacy Services activities including claim utilization analysis, prescription plan design, ad-hoc reporting, correspondence and special projects.
Must maintain performance in compliance with organizational or department goals and in compliance with regulatory agencies.
Serves as a backup for department supervisor as needed.
Process prior authorizations received via prior authorization help line, by evaluating the medical necessity / appropriateness for specific drugs and based on medical criteria.
Conduct intervention with physician and pharmacy office staff to facilitate formulary compliance and generic dispensing.
e. drug pricing, to support market business units and provider service areas.
Core Individual Contributor Competencies :
Personal and professional attributes that are critical to successful performance for Individual Contributors :
Customer Focus
Accountable
Learn
Communicate
Education / Experience :
Additional licensing, certifications, registrations :
Pharmacy Certification
Knowledge :
Skills and Abilities :
Demonstrated ability to work in a production focused environment.
Salary Range : $48,600 - $65,100
$48,600 - $65,100
This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to : education, experience, licensure, certifications, geographic location, and internal equity.
This range has been created in good faith based on information known to Horizon at the time of posting. Compensation decisions are dependent on the circumstances of each case.
Horizon also provides a comprehensive compensation and benefits package which includes :
Comprehensive health benefits (Medical / Dental / Vision)
Retirement Plans
Generous PTO
Incentive Plans
Wellness Programs
Paid Volunteer Time Off
Tuition Reimbursement
Horizon Blue Cross Blue Shield of New Jersey is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or status as an individual with a disability and any other protected class as required by federal, state or local law.
Horizon will consider reasonable accommodation requests as part of the recruiting and hiring process.
Last updated : 2024-06-11
Full Time
$157k-177k (estimate)
06/13/2024
09/10/2024
horizonblue.com
Newark, NJ
>50,000
The job skills required for Pharmacy specialist include Customer Service, Problem Solving, Initiative, Managed Care, Written Communication, Customer Focus, etc. Having related job skills and expertise will give you an advantage when applying to be a Pharmacy specialist. That makes you unique and can impact how much salary you can get paid. Below are job openings related to skills required by Pharmacy specialist. Select any job title you are interested in and start to search job requirements.
The following is the career advancement route for Pharmacy specialist positions, which can be used as a reference in future career path planning. As a Pharmacy specialist, it can be promoted into senior positions as a Pharmacist Manager that are expected to handle more key tasks, people in this role will get a higher salary paid than an ordinary Pharmacy specialist. You can explore the career advancement for a Pharmacy specialist below and select your interested title to get hiring information.