Job Description
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Role Description
- The Pharmacy Clinical Coordinator – UM Specialist supports the Cleveland Clinic Employee Health Plan (EHP) by assisting with the overall operation of the prescription drug benefit, with a primary focus on utilization management.
- Embedded within a multidisciplinary team of pharmacists and pharmacy technicians
- Works closely with UM pharmacists who manage referral queues and conduct initial clinical reviews of prior authorizations
- Routes cases to medical directors when needed
- Supports formulary and utilization management programs
- Assists with referral processing and learning appeals that advance to committee review
- Cross-trained across related functional areas, including formulary management and coordinated care
- Gains exposure to policy development, coverage criteria, and member education
- Contributes to efficient, compliant, and clinically appropriate benefit operations
This is a remote position. A caregiver in this role will work 8:00am to 5:00pm. No weekend, holiday, or on-call requirements.
- A caregiver who excels in this role will:
- Provide formulary and utilization management (UM) strategy to support the internal EHP Pharmacy and Therapeutics (P&T) committee
- Review pharmacy benefit prior authorization, step therapy, and formulary exception requests
- Develop and update pharmacy formulary criteria relating to therapeutic drug classes and individual medications covered under the pharmacy and medical benefits
- Serve as subject matter expert for formulary and UM recommendations to all segments of the EHP business
- Respond to physician and member inquiries relating to the prescription drug program
- Participate in peer-to-peer reviews with EHP Medical Directors and requesting physicians
- Work in collaboration with the EHP Pharmacy Director to design and implement EHP programs for best practices
- Create educational lectures and materials for EHP members and staff
- Generate cost-utilization reports on a regular basis and evaluate the impact of targeted formulary initiatives on internal savings
- Maintain a database for all utilization management approvals and denials
- Partner across Cleveland Clinic Pharmacy Enterprise teams and provide expertise for interdepartmental meetings
- Qualifications
- Bachelor's degree in Pharmacy or PharmD from an accredited school of Pharmacy
- Current State licensure as a Registered Pharmacist (RPh)
- Two years of clinical pharmacy experience or one year of managed care pharmacy experience (Completion of a Pharmacy Residency or Fellowship may offset the required experience)
- Requirements
- Completion of Pharmacy Residency/Fellowship training or equivalent work experience highly desired
- Prior experience as a UM pharmacist
- Physical Requirements
- Requires the ability to sit and be stationary for prolonged periods of time
- Normal or corrected vision
- Manual dexterity sufficient to perform work on a computer
- Ability to walk to various locations throughout the health system
- Personal Protective Equipment
- Follows standard precautions using personal protective equipment as required
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