Summary
Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but we've 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 nation's 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!
Description
Position Purpose:
Responsible for developing, implementing, maintaining, and evaluating pharmacy and medical-pharmacy formularies across all lines of business. This position serves as a clinical subject matter expert supporting formulary strategy, Pharmacy and Therapeutics (P&T) Committee decisions, coverage management programs, and formulary governance activities to ensure safe, effective, clinically appropriate, compliant, and cost-effective medication use while supporting organizational and member health outcomes.
Location:
This position is located at 4101 Percival Road, Columbia SC. You will work the typical hours of 8am - 5pm, Monday through Friday. This position is eligible for a remote schedule after training.
What You'll Do:
- Develops, maintains, and optimizes pharmacy and medical-pharmacy formularies across assigned lines of business. Evaluates formulary performance, implements approved formulary decisions, and supports formulary governance activities to ensure accurate and timely formulary administration. Collaborates with internal and external stakeholders to support formulary design, implementation, and continuous improvement efforts.
- Evaluates clinical literature, treatment guidelines, FDA approvals, and therapeutic alternatives to support formulary decision-making. Prepares clinical reviews, drug monographs, and formulary analyses and provides recommendations regarding formulary additions, exclusions, restrictions, and other coverage strategies. Supports Pharmacy and Therapeutics Committee activities and implementation of approved recommendations.
- Supports formulary operational activities by maintaining the accuracy and integrity of formulary information within pharmacy systems, formulary databases, and vendor platforms. Supports formulary coding, configuration, and implementation activities, including maintenance and validation of drug classifications, NDC, HCPCS, J-code, GPI, and related formulary information to ensure accurate administration of pharmacy and medical-pharmacy benefits. Performs testing, validation, and quality assurance activities to ensure formulary changes are accurately implemented and reflected in member-facing and provider-facing materials. Identifies and resolves issues that may affect benefit administration, claims processing, regulatory compliance, or member access to medications.
- Collaborates with Clinical Pharmacy and Utilization Management teams to ensure alignment between formulary strategies and medication management programs. Supports the implementation and administration of prior authorization, step therapy, quantity limit, site-of-care, and specialty medication strategies. Participates in initiatives designed to improve medication utilization, quality outcomes, affordability, and consistency across pharmacy and medical-pharmacy benefits.
- Supports compliance with applicable regulatory, accreditation, and organizational requirements related to formulary management activities. Maintains documentation supporting formulary decisions, participates in audits and regulatory reviews, and monitors industry and regulatory developments affecting pharmacy benefit management. Collaborates with cross-functional stakeholders to ensure effective implementation of formulary initiatives and achievement of business objectives.
- Assist in special projects as assigned by management
To Qualify For this Position, You'll Need The Following:
Required Education:
- Doctor of Pharmacy (PharmD)
Required Work Experience:
- 3 years of job-related experience
Required Skills and Abilities:
- Healthcare Common Procedure Coding Systems (HCPCS)
- Regulatory Knowledge
- Data Quality
Required Licenses and Certificates:
- Active, unrestricted Pharmacist license in the United States and state of hire.
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
- On-site cafeterias and fitness centers in major locations
- National discounts to movies, theaters, zoos, theme parks and more
What We Can Do for You:
We 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 disabilities and 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 mycareer.help@bcbssc.com or call 800-288-2227, 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. Here's more information.
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