Professional Resident (Medicaid)

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

What You'll Do

Responsibilities:

• Pharmacy case management.

• Development of therapeutic class reviews and drug monographs.

• Formulary development.

• Disease state management.

• Development of clinical policies.

• Prior authorization process.

• Drug utilization review.

• Outcomes research.

• Unique focus on government programs.

• Professional skills development and business administration.

• Assist with Pharm.D. student oversight.

What You Bring

Education/Experience:

• Requires a bachelor's of science degree in pharmacy from an accredited college or university.

• Requires a Pharm D from an accredited college or university.

• Letter of Intent

• Curriculum Vitae

• Three Letters of Recommendation

Additional licensing, certifications, registrations:

• Active Unrestricted Pharmacist License Required Only If Making UM Decisions; NJ License Preferred.

Knowledge:

• Requires knowledge of a spreadsheet software package.

• Requires knowledge of a database software package.

• Requires project management knowledge.

• Requires knowledge of internet clinical information databases.

Skills and Abilities:

• Requires the ability to utilize a personal computer and applicable software.

• Requires the ability to think analytically.

• Requires excellent verbal and written communication skills.

• Requires strong organizational skills.

• Requires the ability to analyze medical literature, i.e. clinical trials

This is a pipeline requisition for the 2027 Pharmacy Residency Program, not currently an open position.

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:

​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

Disclaimer:

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.