Pharmacy Utilization Management Specialist | Hybrid | Newark, NJ | Contract

Pharmacy Utilization Management Specialist | Hybrid | Newark, NJ | Contract

Walker Healthforce is seeking a Pharmacy Utilization Management Specialist with 2+ years of experience to provide prior authorization processing, prescription claim support, and pharmacy utilization management services. This is a Contract opportunity.

Start Date: ASAP
Location: Hybrid – Newark, NJ
Hours/Schedule: Monday-Friday, 40 hours
Worker Type: W2

Core Requirements:

• 2+ years of third-party prescription program claim adjudication experience
• 2+ years of Pharmacy Utilization Management Specialist experience
• Prior customer service/service quality initiative experience
• Experience with prior authorizations, pharmacy claims, coverage determinations, and medical criteria

We Consider It A Bonus If You Also Have:

• Bachelor's degree in Health Care Management, Business, Pharmaceutical Administration, or a related field

Job Responsibilities:

• Process prior authorization requests and evaluate medical necessity and appropriateness based on established criteria
• Support members, physician offices, pharmacies, and internal stakeholders with eligibility, coverage, and claims issues
• Assist with formulary compliance and generic dispensing initiatives
• Process appeals, complaints, inquiries, and compliance-related issues
• Support ad-hoc reporting and information requests
• Assist with pharmacy department operations, Medication Therapy Management, and clinical pharmacy programs
• Participate in training related to pharmacy services programs and operations

What We Offer:

• Competitive compensation package
• Weekly pay via Direct Deposit
• Medical, Dental & Vision available
• 401k options

Why Work With Walker?

• Access to our top ranked team of recruiting and placement specialists
• Continuous, one-on-one support from a dedicated engagement manager
• Professional resume development and interview preparation

Contact our Recruiting Team today to experience the Walker Healthforce difference!

About Us:
Walker Healthforce is known as the dominant force of performance, precision, expertise, and integrity in the healthcare consulting community! As a certified WMBE, we provide end-to-end healthcare IT and clinical solutions to hospitals, health systems, and payer organizations, including Fortune 100 firms nationwide. We are healthcare experts, we're custom not commodity and we've been exceeding expectations for nearly 20 years. Join forces with us to experience unparalleled results today!

We are an Equal Opportunity Employer committed to a culturally diverse workforce. All qualified applicants will receive consideration for employment.