Role Description This position is posted by Jobgether on behalf of a partner company. We are currently looking for a Healthcare Consulting Manager - REMOTE. In this role, you will be at the forefront of driving meaningful changes in the healthcare sector. Your expertise will guide healthcare organizations in optimizing their processes and enhancing the quality of patient care. You will collaborate with a diverse team, leading projects that are instrumental in fostering innovation and achieving better healthcare outcomes. If you are passionate about mentorship and leadership in clinical documentation, this opportunity allows you to make a significant impact in a rapidly evolving environment while furthering your growth and that of your team. - Manage complex multi-workstream projects and oversee junior team members - Analyze data to implement performance improvement and organizational change - Collaborate with team members and clients to align with business objectives - Communicate effectively with project teams and stakeholders - Lead and develop team members through training, supervision, and feedback Qualifications - BA/BS in Nursing with certifications in CCDS required - A minimum of 5 years of acute care hospital experience (ICU, Med/Surg, ER required) - A minimum of 5 years in a clinical documentation integrity role - Relevant experience in a project-based operations performance improvement role within a hospital/clinical setting - Minimum 1 year of experience managing major projects for large, complex healthcare organizations - Strong leadership and management skills aligning to Huron’s core values and competencies - The ability to travel based on client, enterprise, or project needs - Proficiency in Microsoft Office (Word, PowerPoint, Excel) - US Work Authorization required Benefits - Competitive salary range of $140,000 - $200,000 based on experience - Eligibility for annual incentive compensation program - Comprehensive benefits package including medical, dental, and vision coverage - Opportunities for career growth and professional development - Supportive work environment promoting innovation and respect

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 This position is accountable for supporting Pharmacy clinical management. The responsibilities include assisting in formulary management, medication therapy management, utilization management, research and collaboration with disease management and medical management. What You'll Do - Supports the pharmacy formulary management program, medication therapy management program, and related P&T committee activities. - Supports prior authorization program by handling prior authorization requests from Pharmacies and physicians through existing policies and procedures. - Interfaces with medical directors, and other areas for Pharmacy related initiatives - Supports the Utilization management program. - Responsible for member interface through comprehensive medication review for Medicare beneficiaries. - Assist in managing and training Pharmacy techs for Medication therapy management. - Responsible for Medicare beneficiaries pharmacy management program, understand the mandates and follow the guidelines. - Supports clinical programs both internally and externally. - Assists with the internal drug information services. - On call responsibility as required. - Reviews and analyze reports on utilization management, and evaluates business needs for data analysis. - Support the Drug Utilization review program. - Manage and update formulary communications. - Coordinates projects with activities performed by other clinical Pharmacists for the residents and students. - Participates in the Pharmacy Case Management Program. - Supports the pharmacy lock-in program including profile review and presentation. - Maintains and reports relevant drug pipeline/patent loss detail to medical team. - Supports the timely review of Pharmacy appeals. - Assists in the creation of member and provider newsletters. What You Bring Education/Experience: - Requires a bachelor's of science degree in pharmacy from an accredited college or university. - Prefers a Pharm D from an accredited college or university. - Prefers up to one to two year experience in managed care. - Requires retail, or other pharmacy experience. Additional licensing, certifications, registrations: - Active Unrestricted NJ Pharmacy License Required Knowledge: - Requires working knowledge of pharmaceutical and managed care industries. - Requires knowledge of a spreadsheet software package. - Requires knowledge of a database software package. - Requires knowledge of Clinical therapeutics and basic therapy and guidelines and recommendations. - Requires knowledge of Internet clinical information databases. Skills and Abilities: - Strong negotiation skills with the demonstrated sales ability to convert prospect to client in addition to demonstrated persuasive skills with carriers - Must have effective verbal and written communication skills and demonstrate the ability to work well within a team. Demonstrated ability to deliver highly technical information to less technical individuals. - Must demonstrate professional and ethical business practices, adherence to company standards, and a commitment to personal and professional development. - Proven time management skills are necessary. Must demonstrate the ability to manage multiple priorities [or tasks], deliver timely and accurate work products with a customer service focus, and respond with a sense of urgency as required. Demonstrated ability to work in a production focused environment. - Proven ability to exercise sound judgment and strong problem solving skills. - Proven ability to ask probing questions and obtain thorough and relevant information. - Must be client service focused with effective ability to empathize. - Needs to demonstrate willingness to cross-train, and be cross-trained, in other roles/duties. - Must be detail oriented with strong organizational and data processing skills. Proven ability to follow detailed instructions is essential, along with proven problem solving skills. - Proven analytical, research and problem solving skills a must. - Must demonstrate the ability to learn quickly and apply learning to new situations. Must exhibit flexibility to change as appropriate. - Must demonstrate the ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public. - Exhibits an energetic, inquisitive, positive approach to problem solving. - Demonstrated ability to make decisions with little need for direction and to function effectively as a team-oriented, self-starter working across cross-functional lines. - Experience in successfully leading cross-functional teams to achieve improvements. - Must have a demonstrated ability to expand new business, grow client relationships and obtain client referrals. - Must have strong entrepreneurial business development, negotiation, relationship building, and networking skills. - Demonstrated management experience with a focus on customer service, goal setting, and coaching. Exhibits proven leadership, delegation and project management skills. - Proven ability to influence without authority. - Must be able to share own professional insights, expertise, and knowledge to develop critical thinking across the business. - Proven leadership skills in direct and matrix reporting structures - Collaborates on planning and executing the sales strategy, involvement in presentations, and participation in client meetings as appropriate. 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: $97,800 - $133,455 ​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.

Why Patients Need You Everything we do, every day, is in line with an unwavering commitment to the quality and the delivery of safe and effective products to patients. Our science and risk-based compliant quality culture is innovative and customer oriented. Whether you are involved in manufacturing, testing, or compliance, your contribution will directly impact patients. What You Will Achieve All over the world, Pfizer colleagues work together to positively impact health for everyone, everywhere. Our colleagues can grow and develop a career that offers both individual and company success; be part of an ownership culture that values diversity and where all colleagues are energized and engaged; and can impact the health and lives of millions of people. Pfizer, a global leader in the biopharmaceutical industry, is continuously seeking top talent who are inspired by our purpose to innovate to bring therapies to patients that significantly improve their lives. Pfizer is advancing in Neuroscience, and an integral part of the Migraine Team’s mission is to promote a breakthrough therapy for patients suffering from migraine. The Neuroscience Health & Science Professional (HSP) is responsible for increasing territory sales and relationship development with assigned customers and accounts by engaging in product promotion and determining the best strategies to manage their business. The HSP should possess customer, market, and business acumen, analytical skills, and strong product and disease state knowledge; demonstrate ability to drive sales, promotional and strategic business development and management skills, and in-depth customer engagement expertise both in-person and virtually; demonstrate outstanding communication and teamwork skills; be adept in the operation of digital and virtual tools; and be effective at working remotely in collaboration with cross-functional internal teams to address customer needs and compliantly deliver on Pfizer business objectives. How You Will Achieve It - Drives sales in assigned territory - Engages with customers both face to face and virtually - Develops and implements effective business and territory call plans; effectively identifies and implements live/virtual engagement strategies with customer to maximize overall effectiveness and impact - Effectively builds rapport and relationships with customers in both live and virtual environments; uses judgment to maintain customer engagement by successfully utilizing existing and ever-changing digital tools effectively for successful customer engagement - Understands and leverages internal reports and analytics to assist with identifying, developing, and implementing strategic business opportunities - Compliantly leverages product and disease state knowledge to appropriately educate providers on unbranded and branded product value proposition for relevant patient populations and effectively and strategically utilizes approved clinically oriented disease state information and patient resources, as applicable - Demonstrates strong teamwork capabilities to collaborate effectively and compliantly across the organization to address customer inquiries and advance Pfizer objectives. - Completes all administrative expectations on time and compliantly. Qualifications Must-Have - Bachelor’s Degree - Minimum 2 years of experience in one or more of the following; OR an associate’s degree with 6+ years of experience; OR high school diploma (or equivalent) with 8+ years of relevant experience: - Professional Sales or Promotional Activity - Small Business Owner or other Entrepreneurial experience, Marketing, Customer Service and/or Account Management - Relevant Healthcare/Scientific roles (e.g., RN, Pharmacist, PT, OT, etc.) - Educator (e.g., Teacher, Principal) - Full Time Military experience - Must live within 25 miles of the border of the territory. - Valid US driver’s license and driving record in compliance with company standards. Any DUI/DWI or other impaired driving citation within the past 7 years will disqualify you from being hired. - Ability to travel to all accounts/office locations within territory - Depending on size of territory and business need, candidates may be required to stay overnight as necessary Nice-to-Have - 1 year of pharmaceutical, biotech, medical sales and/or medical related marketing. - Strong track record of sales or marketing success, strong territory management skills, outstanding communications skills, as well as demonstrated teamwork, leadership ability and accountability. - Experience with applicable disease states, therapeutic area, and products. - Knowledge of posted territory customers and markets (prescribers/HCPs/institutions/organizations). - Reside within the territory boundaries. Other Job Details: - Last Day to Apply: April 3, 2026 - The annual base salary for this position ranges from $71,700 to $186,700. During initial new hire sales training, you will be classified as a salary non-exempt employee which entitles you to overtime pay. Upon your training certification, you will become an overtime exempt employee. In addition, this position offers an additional quarterly Sales Incentive bonus. We offer comprehensive and generous benefits and programs to help our colleagues lead healthy lives and to support each of life’s moments. Benefits offered include a 401(k) plan with Pfizer Matching Contributions and an additional Pfizer Retirement Savings Contribution, paid vacation, holiday and personal days, paid caregiver/parental and medical leave, and health benefits to include medical, prescription drug, dental and vision coverage. Learn more at Pfizer Candidate Site – U.S. Benefits| (uscandidates.mypfizerbenefits.com). Pfizer compensation structures and benefit packages are aligned based on the location of hire. The United States salary range provided does not apply to any location outside of the United States. Relocation assistance may be available based on business needs and/or eligibility. Candidates must be authorized to be employed in the U.S. by any employer. U.S. work visa sponsorship (such as TN, O-1, H-1B, etc.) is not available for this role now or in the future. Sunshine Act Pfizer reports payments and other transfers of value to health care providers as required by federal and state transparency laws and implementing regulations. These laws and regulations require Pfizer to provide government agencies with information such as a health care provider’s name, address and the type of payments or other value received, generally for public disclosure. Subject to further legal review and statutory or regulatory clarification, which Pfizer intends to pursue, reimbursement of recruiting expenses for licensed physicians may constitute a reportable transfer of value under the federal transparency law commonly known as the Sunshine Act. Therefore, if you are a licensed physician who incurs recruiting expenses as a result of interviewing with Pfizer that we pay or reimburse, your name, address and the amount of payments made currently will be reported to the government. If you have questions regarding this matter, please do not hesitate to contact your Talent Acquisition representative. EEO & Employment Eligibility Pfizer is committed to equal opportunity in the terms and conditions of employment for all employees and job applicants without regard to race, color, religion, sex, sexual orientation, age, gender identity or gender expression, national origin, disability or veteran status. Pfizer also complies with all applicable national, state and local laws governing nondiscrimination in employment as well as work authorization and employment eligibility verification requirements of the Immigration and Nationality Act and IRCA. Pfizer is an E-Verify employer. This position requires permanent work authorization in the United States. Pfizer endeavors to make www.pfizer.com/careers accessible to all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process and/or interviewing, please email disabilityrecruitment@pfizer.com. This is to be used solely for accommodation requests with respect to the accessibility of our website, online application process and/or interviewing. Requests for any other reason will not be returned. Sales

• Provide leadership and day-to-day physician oversight for utilization management team, including the management of high-risk cases and medical necessity decisions • Provide comprehensive behavioral health care management to facilitate delivery of appropriate quality care and improve program/operational efficiency involving clinical issues • Participate in the appeals process, including the investigation of adverse events and quality of care concerns • Provide psychiatric leadership to an interdisciplinary utilization management team, including medical/clinical oversight, consultation and training • Provide day-to-day physician oversight including management of high-risk cases throughout treatment/levels of care and medical necessity decisions • Assist with the development, implementation, monitoring and evaluation of the utilization management program and action plan, ensuring quality and appropriateness of care • Assist with the development, implementation and interpretation of medical policy including medical necessity criteria, clinical practice guidelines and new technology assessments • Participate in the development, implementation, and evaluation of clinical/medical programs • Confer with behavioral health practitioners regarding the care of patients with severe, complex and/or treatment resistant illnesses • Identify and address quality of care concerns with providers involved in a member's care • Provide psychiatric leadership for NCQA-compliant clinical quality improvement activities in collaboration with clinical and quality improvement staff • Participate in the triage and referral for care management • Provide weekend coverage every 6-7 weeks. • Perform other duties as deemed necessary.