New Jersey Licensed Pharmacy Specialist

Job Summary

Supporting pharmacy services in a full-time remote capacity, the New Jersey Licensed Pharmacy Specialist will manage prior authorization requests, engage with healthcare providers, and ensure compliance with regulatory standards.

Key responsibilities

• Handle telephonic interactions regarding pharmacy eligibility, coverage determinations, and claim issues
• Conduct clinical interventions to facilitate formulary compliance and optimize dispensing practices
• Process complaints, appeals, and grievances while identifying potential fraud, waste, and abuse

Required qualifications

• High School Diploma/GED required
• Minimum of two years of experience as a Pharmacy Technician
• National Pharmacy Technician Certification (PTCB or ExCPT) required
• Knowledge of third-party prescription program claim adjudication
• Understanding of managed care principles and common medical terminology