Utilization Managment Pharmacy Manager
Utilization Managment Pharmacy Manager
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Job Description
Summary
Responsible for overseeing and managing the clinical pharmacy team that performs utilization management reviews of prior authorization requests for medications by applying clinical guidelines and criteria to ensure appropriate use of medications. Responsible for also developing and maintaining clinical rules and decision trees used for evaluation and decision making of prior authorization requests. Performs outreach to inform and educate patients and their providers about opportunities to optimize medication related outcomes ensure patient safety and utilize cost effective therapies. Collaborates with other health professionals to ensure that medications prescribed for patients contribute to the best possible health outcomes.
Description
Why should you join the BlueCross BlueShield of South Carolina family of companies Other companies come and go but weve been part of the national landscape for more than seven decades with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina and much more. We are one of the nations leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies allowing us to build on various business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy consider joining our team!
Position Purpose:
Responsible for overseeing and managing the clinical pharmacy team that performs utilization management reviews of prior authorization requests for medications by applying clinical guidelines and criteria to ensure appropriate use of medications. Responsible for also developing and maintaining clinical rules and decision trees used for evaluation and decision making of prior authorization requests. Performs outreach to inform and educate patients and their providers about opportunities to optimize medication related outcomes ensure patient safety and utilize cost effective therapies. Collaborates with other health professionals to ensure that medications prescribed for patients contribute to the best possible health outcomes.
Location:
This position is full-time (40-hours/week) Monday-Friday in a typical office environment or from your home. You will work an 8-hour shift scheduled during our normal business hours of 8:00AM-5:00PM. It may be necessary given the business need to work occasional overtime. You may be required to travel between buildings. This role is located at 4101 Percival Road Columbia SC 29229.
What Youll Do:
- Oversees and manages the clinical pharmacy team that performs utilization management prior authorization reviews and evaluates opportunities to improve health outcomes and derive optimal value from health care resources.
- Develops and maintains clinical criteria and rules for evaluation of prior authorization requests to ensure appropriate medication use and encourage cost effective prescribing by providers.
- Develops programs and strategies to optimize patients medication regimens applying evidence-based medicine and national treatment guidelines.
- Develops and manages programs that inform prescribers of potential drug therapy problems and influence prescribing.
- Engages with and establishes credibility with members and providers as a trusted source of information.
- Provides information and coordinates activities with other care and disease management programs and serves as a clinical pharmacy resource.
- Supervises clinical pharmacists and supporting staff. Provides direction and guidance. Establishes goals. Responsible for completing annual performance review.
- Engages in multi-disciplinary UM committees and serves as the pharmacy department representative for updates and strategy discussions.
To Qualify For This Position Youll Need The Following:
- Required Education: Bachelors degree in Pharmacy or Doctorate in Pharmacy
- Required Work Experience: 3 years of clinical pharmacy experience (to include 1 year of experience with management of patient drug therapies involving conducting utilization management reviews) and 3 years of experience managing clinical pharmacy programs. 2 years of supervisory/team lead experience or equivalent military experience in grade E4 or above (may be concurrent).
- Required Skills and Abilities: Strong clinical pharmacy knowledge. Excellent communication (verbal and written) and interpersonal skills. Ability to exercise good judgment with a capacity of communicating with a diverse range of individuals. Ability to handle confidential or sensitive information with discretion. Strong customer service skills. Commitment to professionalism and to advance patient care.
- Required Software and Tools: Microsoft Office.
- Required Licenses and Certificates: Active unrestricted pharmacy licensure in SC or state of residence.
We Prefer That You Have The Following:
- Preferred Training: Any additional certifications in Medication Therapy Management immunotherapy oncology hemophilia multiple sclerosis or specialty related disease states is helpful.
- Preferred Work Experience: Utilization Management program experience preferred including working with prior authorization program platforms. Managed Medicaid experience working with preferred drug lists and UM criteria application.
- Preferred Skills and Abilities: Knowledge and expertise with management of specialty drug therapies.
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.
Some states have required notifications. Heres more information.
Required Experience:
Manager
Employment Type
Full-Time
