Location:

This position is full-time (40 hours/week) Monday-Friday from 8:00 am 5:00 pm ET and will be hybrid in Columbia SC.

What Youll Do:

• Receives and builds cases in the various applications for pharmacy authorization requests. Under Pharmacist guidance and per company policies/guidelines and established criteria sets reviews evaluates and authorizes approval of pharmacy requests. Requests additional information from providers including confidential medical history and prior drug therapy in order to properly evaluate the request. Determines appropriateness for medications. Processes determination letters and communicates decision to providers and/or members ensuring timeliness and accuracy. Researches resolves and documents outcomes in pharmacy system. Communicates selected authorization criteria pharmacy benefit coverage formulary alternatives and/or Pharmacy Management program policies and procedures to pharmacy providers members and internal contacts. Conducts research necessary to make thorough/accurate basis for each determination made.

• Loads authorization into the system and ensures the clinical determination is documented accurately into the system for all levels of care. Utilizes allocated resources to back up review determinations. Completes all assigned work within established timeliness guidelines.

• Identifies and makes referrals to appropriate staff (Pharmacist Case Manager Preventive Services Subrogation Quality of Care Referrals etc.). Escalates requests to Pharmacist when request requires extensive clinical review.

• Establishes and maintains effective relationships with providers members and internal contacts. Responds appropriately to inquiries received from providers members and internal contacts. Researches and resolves issues using the appropriate reference material.

• Participate in quality control and/or quality improvement activities in support of the corporate and team-based objectives. Participate in all Required Licenses and Certificates.

To Qualify for This Position Youll Need the Following:

• Required Education: High School Diploma or equivalent

• Required Work Experience: 3 years pharmacy technician experience.

• Required Skills and Abilities: Working knowledge of pharmaceutical claims language drug usage and generic substitution practices.

• Good judgment.

• Demonstrated customer service and organizational skills.

• Demonstrated proficiency in spelling punctuation and grammar skills.

• Analytical or critical thinking skills.

• Ability to handle confidential or sensitive information with discretion.

• Attention to detail and the ability to handle multiple demands and balance multiple priorities in a fast-paced environment.

• Ability to remain in a stationary position and operate a computer.

• Required Software and Other Tools: Microsoft Office.

• Required Licenses and Certificates: Registered Pharmacy Technician with the applicable state Board of Pharmacy and Certified Pharmacy Technician.

We Prefer That You Have the Following:

• Preferred Work Experience: 3 years pharmacy experience in managed care setting or PBM.

• Preferred Work Experience: Previous experience conducting utilization management reviews.

Our Comprehensive Benefits Package Includes the Following:

We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment.

• Subsidized health plans dental and vision coverage

• 401k retirement savings plan with company match

• Life Insurance

• Paid Time Off (PTO)

• On-site cafeterias and fitness centers in major locations

• Education Assistance

• Service Recognition

• National discounts to movies theaters zoos theme parks and more

What We Can Do for You:

We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills advance their careers and contribute their unique abilities to the growth of our company.

What To Expect Next:

After submitting your application our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements.

Equal Employment Opportunity Statement

BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age race color national origin sex religion veteran status disability weight sexual orientation gender identity genetic information or any other legally protected status. Additionally as a federal contractor the company maintains affirmative action programs to promote employment opportunities for individuals with disabilitiesand protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal state and local laws and regulations.

We are committed to working with and providing reasonable accommodations to individuals with disabilities pregnant individuals individuals with pregnancy-related conditions and individuals needing accommodations for sincerely held religious beliefs provided that those accommodations do not impose an undue hardship on the Company.

If you need special assistance or an accommodation while seeking employment please email or call ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.

We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Heres moreinformation.

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