Facebook · 2 weeks ago
Utilization Management Pharmacist
Columbia, South Carolina
Full-time
Hybrid
Mid Level
3+ years expBlueCross BlueShield of South Carolina is a leading insurance provider with a strong community presence. This role is primarily responsible for developing and maintaining clinical decision-support logic within the prior authorization review platform and supporting PA processing by applying evidence-based clinical guidelines to promote appropriate medication use.
Computer Software
Responsibilities
Conducts utilization management prior authorization reviews and evaluates opportunities to improve health outcomes and derive optimal value from health care resources
Analyzes and reviews prior authorization requests for compliance with clinical criteria and treatment care guidelines, potential patient safety problems, including drug interactions, suboptimal medication regimens, duplicate therapy and cost savings opportunities
Formulates recommendations to optimize the patients’ medication regiment applying evidence based medicine and national treatment guidelines
Informs prescribers of potential drug therapy problems and influences prescribing
Engages with and establishes credibility with members and physicians 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
Contributes to the development of clinical rules and decision trees for evaluating the appropriateness of drug therapy
Qualification
Required
Bachelor's in a job related field
3 years of clinical experience to include 1 year of experience with management of patient drug therapies that includes conducting utilization management and/or medication therapy management reviews
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
Microsoft Office
Active, unrestricted pharmacy licensure in SC or state of residence
Preferred
Any additional certifications in Medication Therapy Management, immunotherapy, oncology, hemophilia, multiple sclerosis, or specialty related disease states is helpful
Utilization Management program experience preferred including working with prior authorization program platforms
Managed Medicaid experience working with preferred drug lists and UM criteria application
Knowledge and expertise with management of specialty drug therapies
Benefits
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
Company
The Facebook company is now Meta. Meta builds technologies that help people connect, find communities, and grow businesses.
10001+ employees
H1B Sponsorship
Facebook has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2022 (942)
2021 (5811)
2020 (4476)
Funding
Current Stage
Late StageLeadership Team
Arunava Chatterjee
Executive Director of Ghost Black Operations & CEO & CTO
Shubhra Gupta
CEO
Recent News
Business Live
2025-11-03
2025-11-01
Company data provided by crunchbase