Pharmacy Utilization Management Specialist - Hybrid - Newark, NJ
Job in
Newark, Essex County, New Jersey, 07175, USA
Listed on 2026-10-12
Listing for:
Walker Healthforce, Inc.
Full Time, Contract
position Listed on 2026-10-12
Job specializations:
-
Healthcare
Healthcare / Medical Sales, Healthcare Administration
Job Description & How to Apply Below
Pharmacy Utilization Management Specialist | Hybrid | Newark, NJ | Contract
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
- Bachelor's degree in Health Care Management, Business, Pharmaceutical Administration, or a related field
- 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
- Competitive compensation package
- Weekly pay via Direct Deposit
- Medical, Dental & Vision available
- 401k options
- 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
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.
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