Our client, is a Health Insurance company, is looking for a Pharmacy Specialist Level 1 for their Newark, NJ/Hybrid location. Responsibilities:

+ This position is responsible for receiving verbal and written requests for prior authorization from pharmacists, physicians and/or patients and is responsible for supporting and assisting in the coordination of Pharmacy Services activities including claim utilization analysis, prescription plan design, ad-hoc reporting, correspondence and special projects. Must maintain performance in compliance with organizational or department goals and in compliance with regulatory agencies

+ Process prior authorizations received via prior authorization help line, by evaluating the medical necessity/appropriateness for specific drugs and based on medical criteria.

+ Directly interact with members physician office staff, pharmacies and internal stake holders for eligibility, coverage determination claims issues.

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