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Pharmacy Specialist Level 1

Iconma

Newark, NY

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JOB DETAILS
LOCATION
Newark, NY
POSTED
8 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?
  • Health Benefits
  • Referral Program
  • Excellent growth and advancement opportunities
 
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

I

Iconma

ICONMA is a global information consulting management firm providing Professional Staffing Services and Project-Based Solutions for organizations in a broad range of industries.

  • Corporate Headquarters in Troy, Michigan; 20+ locations worldwide.
  • Certified Woman-Owned Business Enterprise (WBE); certified by Women’s Business Enterprise National Council, National Women Business Owners Corporation (NWBOC); and California Public Utilities Commission (CPUC).
  • Founded in 2000
  • 2000+ Employees

The company was founded on the principle that success is derived from delivering high quality service and resources in the most responsive, flexible, and innovative way. ICONMA invests in people and resources with a single goal: To provide our customers with the highest quality service in the most responsive manner. Through its network of offices, ICONMA provides the resources to help clients maintain their competitive advantage.

COMPANY SIZE
2,000 to 2,499 employees
INDUSTRY
Management Consulting Services
EMPLOYEE BENEFITS
401K, Employee Referral Program, Life Insurance
FOUNDED
2000
WEBSITE
https://www.iconma.com/