Note: The job is a remote job and is open to candidates in USA. Horizon Blue Cross Blue Shield of New Jersey is a leader in health solutions, dedicated to improving healthcare quality and member experience for over 90 years. The Clinical Pharmacist role involves supporting pharmacy clinical management, including formulary management, medication therapy management, and utilization management, while collaborating with various healthcare professionals.
Responsibilities
- Supports the pharmacy formulary management program, medication therapy management program, and related P&T committee activities
- Supports prior authorization program by handling prior authorization requests from Pharmacies and physicians through existing policies and procedures
- Interfaces with medical directors, and other areas for Pharmacy related initiatives
- Supports the Utilization management program
- Responsible for member interface through comprehensive medication review for Medicare beneficiaries
- Assist in managing and training Pharmacy techs for Medication therapy management
- Responsible for Medicare beneficiaries pharmacy management program, understand the mandates and follow the guidelines
- Supports clinical programs both internally and externally
- Assists with the internal drug information services
- On call responsibility as required
- Reviews and analyze reports on utilization management, and evaluates business needs for data analysis
- Support the Drug Utilization review program
- Manage and update formulary communications
- Coordinates projects with activities performed by other clinical Pharmacists for the residents and students
- Participates in the Pharmacy Case Management Program
- Supports the pharmacy lock-in program including profile review and presentation
- Maintains and reports relevant drug pipeline/patent loss detail to medical team
- Supports the timely review of Pharmacy appeals
- Assists in the creation of member and provider newsletters
Skills
- Requires a bachelor's of science degree in pharmacy from an accredited college or university
- Active Unrestricted NJ Pharmacy License Required
- Requires working knowledge of pharmaceutical and managed care industries
- Requires knowledge of a spreadsheet software package
- Requires knowledge of a database software package
- Requires knowledge of Clinical therapeutics and basic therapy and guidelines and recommendations
- Requires knowledge of Internet clinical information databases
- Strong negotiation skills with the demonstrated sales ability to convert prospect to client in addition to demonstrated persuasive skills with carriers
- Must have effective verbal and written communication skills and demonstrate the ability to work well within a team
- Demonstrated ability to deliver highly technical information to less technical individuals
- Must demonstrate professional and ethical business practices, adherence to company standards, and a commitment to personal and professional development
- Proven time management skills are necessary
- Must demonstrate the ability to manage multiple priorities [or tasks], deliver timely and accurate work products with a customer service focus, and respond with a sense of urgency as required
- Demonstrated ability to work in a production focused environment
- Proven ability to exercise sound judgment and strong problem solving skills
- Proven ability to ask probing questions and obtain thorough and relevant information
- Must be client service focused with effective ability to empathize
- Needs to demonstrate willingness to cross-train, and be cross-trained, in other roles/duties
- Must be detail oriented with strong organizational and data processing skills
- Proven ability to follow detailed instructions is essential, along with proven problem solving skills
- Proven analytical, research and problem solving skills a must
- Must demonstrate the ability to learn quickly and apply learning to new situations
- Must exhibit flexibility to change as appropriate
- Must demonstrate the ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public
- Exhibits an energetic, inquisitive, positive approach to problem solving
- Demonstrated ability to make decisions with little need for direction and to function effectively as a team-oriented, self-starter working across cross-functional lines
- Experience in successfully leading cross-functional teams to achieve improvements
- Must have a demonstrated ability to expand new business, grow client relationships and obtain client referrals
- Must have strong entrepreneurial business development, negotiation, relationship building, and networking skills
- Demonstrated management experience with a focus on customer service, goal setting, and coaching
- Exhibits proven leadership, delegation and project management skills
- Proven ability to influence without authority
- Must be able to share own professional insights, expertise, and knowledge to develop critical thinking across the business
- Proven leadership skills in direct and matrix reporting structures
- Collaborates on planning and executing the sales strategy, involvement in presentations, and participation in client meetings as appropriate
- Prefers a Pharm D from an accredited college or university
- Prefers up to one to two year experience in managed care
- Requires retail, or other pharmacy experience
Benefits
- Comprehensive health benefits (Medical/Dental/Vision)
- Retirement Plans
- Generous PTO
- Incentive Plans
- Wellness Programs
- Paid Volunteer Time Off
- Tuition Reimbursement
Company Overview
Horizon Blue Cross Blue Shield of New Jersey is a company that provides health insurance products. It was founded in 1932, and is headquartered in Newark, New Jersey, USA, with a workforce of 5001-10000 employees. Its website is http://www.horizonblue.com.