Clinical Pharmacist

Pharmacy Clinical Management Support

Horizon Blue Cross Blue Shield of New Jersey empowers our members to achieve their best health. For over 90 years, we have been New Jersey's health solutions leader driving innovations that improve health care quality, affordability, and member experience. Our members are our neighbors, our friends, and our families. It is this understanding that drives us to better serve and care for the 3.5 million people who place their trust in us. We pride ourselves on our best-in-class employees and strive to maintain an innovative and inclusive environment that allows them to thrive. When our employees bring their best and succeed, the Company succeeds.

About the Role

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.

What You Bring

Education/Experience:

• 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.

Additional licensing, certifications, registrations:

• Active Unrestricted NJ Pharmacy License Required

Knowledge:

• 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 in addition to demonstrated persuasive skills with carriers
• Must have effective verbal and written communication skills and demonstrate the ability to work well within a team. Demonstrated ability to deliver highly technical information to less technical individuals.
• Must demonstrate professional and ethical business practices, adherence to company standards, and a commitment to personal and professional development.
• Proven time management skills are necessary. Must demonstrate the ability to manage multiple priorities [or tasks], deliver timely and accurate work products with a customer service focus, and respond with a sense of urgency as required. Demonstrated ability to work in a production focused environment.
• Proven ability to exercise sound judgment and strong problem solving skills.
• Proven ability to ask probing questions and obtain thorough and relevant information.
• Must be client service focused with effective ability to empathize.
• Needs to demonstrate willingness to cross-train, and be cross-trained, in other roles/duties.
• Must be detail oriented with strong organizational and data processing skills. Proven ability to follow detailed instructions is essential, along with proven problem solving skills.
• Proven analytical, research and problem solving skills a must.
• Must demonstrate the ability to learn quickly and apply learning to new situations. Must exhibit flexibility to change as appropriate.
• Must demonstrate the ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public.
• 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.
• Experience in successfully leading cross-functional teams to achieve improvements.
• Must have a demonstrated ability to expand new business, grow client relationships and obtain client referrals.
• Must have strong entrepreneurial business development, negotiation, relationship building, and networking skills.
• Demonstrated management experience with a focus on customer service, goal setting, and coaching. Exhibits proven leadership, delegation and project management skills.
• Proven ability to influence without authority.
• Must be able to share own professional insights, expertise, and knowledge to develop critical thinking across the business.
• Proven leadership skills in direct and matrix reporting structures
• Collaborates on planning and executing the sales strategy, involvement in presentations, and participation in client meetings as appropriate.

Why Horizon?

At Horizon, you'll do meaningful work that directly improves lives—while being supported by a mission‑driven organization that values expertise, collaboration, and growth. We believe that when our people thrive, our communities do too. If you are passionate about making an impact, we'd love to hear from you!

Salary Range:

$97,800 - $133,455

This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity. This range has been created in good faith based on information known to Horizon at the time of posting. Compensation decisions are dependent on the circumstances of each case. Horizon also provides a comprehensive compensation and benefits package which includes:

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

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.