Summary
Responsible for performing utilization management reviews of prior authorization request for medications by applying clinical guidelines and criteria to ensure appropriate use of medications. Informs and educates 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

Position Purpose:

Responsible for performing utilization management reviews of prior authorization request for medications by applying clinical guidelines and criteria to ensure appropriate use of medications. Informs and educates 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. You will work an 8-hour shift between the hours of 7am - 7pm. This position is eligible for hybrid work after the training period. This role is located at 4101 Percival Road, Columbia, SC 29229. There is the expectation of rotating weekends and holidays as well.

What You'll Do:

• 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.

To Qualify For This Position, You'll Need The Following:

• Required Education: Bachelor's in a job related field
• Required Work Experience: 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.
• 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 HaveThe 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 our benefits program 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