Full time
BlueCross BlueShield of South Carolina
Columbia, SC, USA
Summary Responsible for setting up cases for pharmacy authorization requests and performing pharmacy reviews as per established criteria. Maintains the timely, complete, and accurate processing of authorization requests by interfacing with internal and external customers and the Pharmacy Benefit Manager (PBM) to resolve issues that may arise in the provision of pharmacy services. Processes determination letters and documents decisions using indicated protocol or clinical guidelines. Participates in quality control and/or quality improvement activities. Description Position Purpose: Responsible for setting up cases for pharmacy authorization requests and performing pharmacy reviews as per established criteria. Maintains the timely, complete, and accurate processing of authorization requests by interfacing with internal and external customers and the Pharmacy Benefit Manager (PBM) to resolve issues that may arise in the provision of pharmacy services....


