Clinical Pharmacist - (Columbia, SC)

ProfessionalPosition Purpose: Define and develop standard and custom formularies for assigned plan. Develop clinical criteria for review of medications, recommend plan design changes and communicate recommendations to client Monitor and review prior authorization requests for medication Develop and design clinical edits to adjudicate claims and enhance drug utilization Analyze pharmacy cost of care, trends, and coordinate the development of appropriate use protocols and guidelines Set criteria for medication analysis, coordinate reports to clients, meet regulatory reporting qualifications for drug utilization review and fraud and abuse reporting Research drug details to maintain drug knowledge and disease state understanding for application to prior authorization reviews Participate in the development and implementation of medication therapy management programs Provide clinical guidance and support to various departments and address clinical related questions