New Jersey Licensed Pharmacy Specialist
Job Summary
Responsible for processing prior authorization requests and engaging with healthcare professionals, the full-time New Jersey Licensed Pharmacy Specialist will support Pharmacy Services by ensuring compliance with regulatory standards and improving operational efficiency while working remotely.
Key responsibilities
- Manage telephonic interactions with members, physicians, and pharmacies regarding eligibility and coverage determinations
- Conduct clinical reviews and interventions to facilitate formulary compliance and optimize medication dispensing
- Process complaints, appeals, and grievances while identifying potential fraud, waste, and abuse in pharmacy services
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 and managed care principles
- Understanding of State of New Jersey Board of Pharmacy regulations
Complete Job Description
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