Pharmacy Business Consultant I
Full Time
Newark, NJ 07105
Posted
Job description
Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware
Job Summary:
This position serves as a liaison with our Pharmacy Benefit Manager (PBM). The incumbent will assist management in coordinating the day-to-day activities of pharmacy benefits and customer service support and PBM oversight. Additionally, the position will provide support for ensuring accountability of pharmacy compliance in regards to implementation of new and/or enhanced products with state and federal laws and mandates and adherence to accrediting agency requirements.
Responsibilities:
- Coordinates pharmacy operations and marketing support to ensure that exceptional customer service is provided on all pharmacy related issues and activities (i.e. Sales support, claim exceptions, RX claims/adjustments, and all inquiries (including cross accumulation issues and appeals) and reporting, etc.).
- Ensures that deliverables are met within established project timelines and budgets.
- Maintains, and organizes a project task force which may consist of internal employees of all levels and/or external consultants.
- Provides support on ensuring a successful transition of new processes and job functions through projects and process improvement initiatives.
- Acts as a liaison to the PBM and supports various activities including PBM oversight, development of internal educational programs, creation and implementation of plan designs, plan design updates and changes.
- Supports the oversight of the PBM interface with Horizon systems and any other systems related issues.
- Provides knowledgeable and sophisticated support to the Market Business Units to ensure consistency in implementation of new/updated product offerings and standards.
- Identify opportunities where reporting and tracking is needed with a proactive approach to manage pharmacy spend, ie. SIU, Retro term. Work with team lead and manager to implement processes as needed.
- Functions as internal Pharmacy Model Audit Rule (MAR) liaison. Assists with preparing and maintaining MAR documents and with identifying gaps and remediate accordingly.
The information above is intended to describe the general nature of the work being performed by each incumbent assigned to this position. This job description is not designed to be an exhaustive list of all responsibilities, duties, and skills required of each incumbent.
Education/Experience:
- Prefers a Bachelors degree from an accredited college or university, preferably in Business Administration, Management, or related field. In lieu of degree, relevant work experience required.
- Requires a minimum of (2) years relative experience, in health care, pharmaceutical, insurance or a related field.
- Prefer multi-divisional BCBSNJ experience.
Additional licensing, certifications, registrations:
- Requires valid drivers license and access to a car.
Knowledge:
- Knowledge of Healthcare Industry required.
- Requires advanced analytical skills and the ability to present/recommend business solutions.
- Must be proficient in the use of personal computers and supporting software in a Windows based environment, including MS Office products (Word, Excel, PowerPoint) and Lotus Notes; Should be knowledgeable in the use of intranet and internet applications.
Skills and Abilities:
- Must have excellent verbal and written communication skills and demonstrate the ability to work well within and across teams.
- Demonstrated management experience with a focus on goal setting and coaching.
- Exhibits proven leadership, delegation and project management skills.
- Must demonstrate professional and ethical business practices, adherence to company standards, and a commitment to personal and professional development.
- Proven ability to influence without authority and the ability to achieve results through others in a decentralized organization without formal reporting relationships.
- Strong facilitator skills in leading large teams.
- Experience in successfully leading cross-functional teams to achieve improvements.
- Ability to manage resources efficiently.
- Proven time management skills. Must demonstrate the ability to manage multiple priorities and tasks, deliver timely and accurate work products with a customer service focus and a sense of urgency.
- Proven analytical, research and problem solving skills.
- Proven ability to ask probing questions and obtain thorough and relevant information.
- Requires excellent interpersonal skills and ability to work with all levels.
- Requires strong presentation skills. Must demonstrate the ability to effectively present information and respond to questions from all levels within the organization.
- Demonstrated ability to achieve goals on time and within budget
Travel % (If Applicable):
- Minimum travel is required.
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.
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