[Hiring] Clinical Pharmacist @Horizon Blue Cross Blue Shield of New Jersey

Role Description

This position is accountable for supporting Pharmacy clinical management. The responsibilities include:

• Assisting in formulary management
• Medication therapy management
• Utilization management
• Research and collaboration with disease management and medical management

What You'll Do:

• 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.

Qualifications

• Requires a bachelor's of science degree in pharmacy from an accredited college or university.
• 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.
• Active Unrestricted NJ Pharmacy License Required.

Requirements

• 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.

Skills and Abilities

• Strong negotiation skills with the demonstrated sales ability to convert prospect to client.
• Effective verbal and written communication skills.
• Ability to work well within a team.
• Demonstrated ability to deliver highly technical information to less technical individuals.
• Professional and ethical business practices.
• Proven time management skills.
• Ability to manage multiple priorities and deliver timely and accurate work products.
• Proven ability to exercise sound judgment and strong problem solving skills.
• Client service focused with effective ability to empathize.
• Detail oriented with strong organizational and data processing skills.
• Proven analytical, research and problem solving skills.
• Ability to learn quickly and apply learning to new situations.
• Ability to effectively present information and respond to questions from groups.
• Energetic, inquisitive, positive approach to problem solving.
• Ability to make decisions with little need for direction.
• Experience in successfully leading cross-functional teams.
• Strong entrepreneurial business development, negotiation, relationship building, and networking skills.
• Demonstrated management experience with a focus on customer service.
• Proven ability to influence without authority.
• Ability to share professional insights to develop critical thinking across the business.
• Proven leadership skills in direct and matrix reporting structures.

Benefits

• Comprehensive health benefits (Medical/Dental/Vision)
• Retirement Plans
• Generous PTO
• Incentive Plans
• Wellness Programs
• Paid Volunteer Time Off
• Tuition Reimbursement

Disclaimer

Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware. This job summary has been designed to indicate the general nature and level of work performed by colleagues within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of colleagues assigned to this job.

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.