Utilization Management Pharmacist

BlueCross BlueShield of South Carolina

. Perform utilization management reviews of medication prior authorization requests using clinical guidelines and criteria .

Posted 10/7/2026full-timeColumbia • South Carolina • United StatesMid-LevelSeniorWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates strong clinical pharmacy knowledge and expertise in medication therapy management, with a focus on optimizing patient medication regimens and ensuring compliance with clinical guidelines. Proficient in communication and collaboration with healthcare professionals to enhance patient safety and cost-effective therapies.

Highest-signal resume keywords

Clinical Pharmacy KnowledgeMedication Therapy ManagementUtilization Management ExperienceActive Pharmacy LicensureMicrosoft Office Proficiency

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Utilization Management ReviewsClinical Criteria AnalysisEvidence-Based RecommendationsDrug Interaction AnalysisCost-Saving Opportunities Identification

Soft Skills

Excellent Communication SkillsInterpersonal SkillsGood JudgmentCustomer Service SkillsProfessionalism

Tools & Technologies

Prior Authorization Program PlatformsCare Management ProgramsDisease Management Programs

Certifications & Qualifications

Medication Therapy Management Certification

Industry Keywords

Medication OptimizationPatient SafetyCost-Effective TherapiesSpecialty Drug TherapiesManaged Medicaid Experience

About the role

Key responsibilities & impact

Perform utilization management reviews of medication prior authorization requests using clinical guidelines and criteria
Inform and educate patients and providers about medication optimization, patient safety, and cost-effective therapies
Collaborate with health professionals to support optimal medication-related health outcomes
Analyze prior authorization requests for clinical criteria compliance, treatment guidelines, drug interactions, suboptimal regimens, duplicate therapy, and cost-saving opportunities
Formulate evidence-based recommendations to optimize patient medication regimens
Inform prescribers of potential drug therapy problems and influence prescribing
Establish credibility with members and physicians as a trusted information source
Coordinate with care and disease management programs and serve as a clinical pharmacy resource
Contribute to clinical rules and decision trees for evaluating drug therapy appropriateness

Requirements

What you’ll need

Bachelor's in a job related field
3 years of clinical experience, including 1 year of experience managing patient drug therapies through utilization management and/or medication therapy management reviews
Strong clinical pharmacy knowledge
Excellent verbal and written communication and interpersonal skills
Ability to exercise good judgment and communicate with a diverse range of individuals
Ability to handle confidential or sensitive information with discretion
Strong customer service skills
Commitment to professionalism and advancing patient care
Microsoft Office proficiency
Active, unrestricted pharmacy licensure in South Carolina or state of residence
Preferred: additional certifications in Medication Therapy Management, immunotherapy, oncology, hemophilia, multiple sclerosis, or specialty-related disease states
Preferred: utilization management program experience, prior authorization program platforms, and managed Medicaid experience with preferred drug lists and UM criteria application
Preferred: knowledge and expertise with specialty drug therapies

Benefits

Comp & perks

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