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Pharmacy Specialist Level 1

ICONMA, LLC

Newark, NY

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JOB DETAILS
SALARY
$16.55–$19.31 Per Hour
SKILLS
Adjudication, Analysis Skills, Biotech and Pharmaceutical, Business Administration, Clinical Support, Customer Service Evaluation, Financial Reporting, Formulary, Health Insurance, Health Plan, Healthcare Management, Maintain Compliance, Medical Office, Medications, Pharmacy, Prescription Drugs, Quality Assurance, Regulatory Compliance, Request for Information (RFI), Staff Training, Utilization Management
LOCATION
Newark, NY
POSTED
30+ days ago
Our client, is a Health Insurance company, is looking for a Pharmacy Specialist Level 1 for their Newark, NJ/Hybrid location.
 
Responsibilities:
  • This position is responsible for receiving verbal and written requests 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
  • 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.
 
Requirements:
  • 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.
 
Why Should You Apply?  
ICONMA is an Equal Opportunity Employer. All qualified applicants will receive considerationfor employment without regard to any status protected by applicable law.
 

About the Company

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ICONMA, LLC