Pharmacy Specialist I

Our Client, a Health Insurance company, is looking for a Pharmacy Specialist I for their Newark, NJ/Hybrid location.
 
Responsibilities:

• Process prior authorizations received via prior authorization help line, by evaluating the medical necessity/appropriateness for specific drugs and based on medical criteria.
• Directly interact with members physician office staff, pharmacies and internal stake holders for eligibility, coverage determination claims issues.
• Conduct intervention with physician & pharmacy office staff to facilitate formulary compliance and generic dispensing.
• Process appeals complaints executive inquiries and compliance related issues.
• Provide recommendations to increase efficiency, accuracy and productivity in the department.
• Process ad hoc request for information or reports from stakeholders.
• Participate in client member and employee training to ensure practical understanding of pharmacy services programs and operations.
• 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.

• Prefers a Bachelor's degree from an accredited college or university in Health Care Management, Business or Pharmaceutical Administration.
• Requires minimum of two (2) years experience in third party prescription program claim adjudication.
• Requires minimum of two (2) years experience as a Pharmacy Utilization Management Specialist.
• Requires prior customer service/service quality initiative experience.

• Health Benefits
• Referral Program
• Excellent growth and advancement opportunities