Community Affairs Analyst

$94,900 - $129,570/Yr

Horizon Blue Cross Blue Shield of New Jersey - Wall Township, NJ

Full-time - Mid Level

Remote - Wall Township, NJ

Insurance Carriers and Related Activities

About the position

The Clinical Pharmacist position at Horizon BCBSNJ is a vital role responsible for supporting the clinical management of pharmacy services. This position encompasses a variety of responsibilities, including formulary management, medication therapy management, and utilization management. The Clinical Pharmacist will collaborate with medical directors and other healthcare professionals to implement pharmacy-related initiatives and ensure compliance with clinical programs both internally and externally. The role also involves direct interaction with Medicare beneficiaries, providing comprehensive medication reviews and managing pharmacy-related programs to meet regulatory mandates. In addition to supporting the pharmacy formulary management program and prior authorization requests, the Clinical Pharmacist will be involved in the Drug Utilization Review program and will assist in the creation of member and provider newsletters. The position requires a proactive approach to managing and training pharmacy technicians, as well as coordinating projects with other clinical pharmacists. The Clinical Pharmacist will also be responsible for analyzing reports on utilization management and evaluating business needs for data analysis, ensuring that the pharmacy services align with the overall goals of the organization. This role demands a strong understanding of pharmaceutical and managed care industries, as well as the ability to communicate effectively with both technical and non-technical audiences. The Clinical Pharmacist must demonstrate strong problem-solving skills, time management abilities, and a commitment to professional development. The position may require on-call responsibilities and participation in various pharmacy programs, making it essential for the Clinical Pharmacist to be adaptable and detail-oriented.

Responsibilities

• 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.

Requirements

• 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.
• 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.

Nice-to-haves

• Strong negotiation skills with the demonstrated sales ability to convert prospect to client in addition to demonstrated persuasive skills with carriers.
• Demonstrated ability to deliver highly technical information to less technical individuals.
• Proven time management skills are necessary.
• Demonstrated ability to work in a production focused environment.
• Proven ability to exercise sound judgment and strong problem solving skills.
• Must demonstrate the ability to learn quickly and apply learning to new situations.
• Exhibits an energetic, inquisitive, positive approach to problem solving.
• Demonstrated ability to make decisions with little need for direction and to function effectively as a team-oriented, self-starter working across cross-functional lines.

Benefits

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