[Hiring] Pharmacy Clinical Coordinator - UM Specialist, EHP @Cleveland Clinic
This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more.
Role Description
The Pharmacy Clinical Coordinator ā 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.
ā¢ Embedded within a multidisciplinary team of pharmacists and pharmacy technicians
ā¢ Works closely with UM pharmacists who manage referral queues and conduct initial clinical reviews of prior authorizations
ā¢ Routes cases to medical directors when needed
ā¢ Supports formulary and utilization management programs
ā¢ Assists with referral processing and learning appeals that advance to committee review
ā¢ Cross-trained across related functional areas, including formulary management and coordinated care
ā¢ Gains exposure to policy development, coverage criteria, and member education
ā¢ 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:
ā¢ Provide formulary and utilization management (UM) strategy to support the internal EHP Pharmacy and Therapeutics (P&T) committee
ā¢ Review pharmacy benefit prior authorization, step therapy, and formulary exception requests
ā¢ Develop and update pharmacy formulary criteria relating to therapeutic drug classes and individual medications covered under the pharmacy and medical benefits
ā¢ Serve as subject matter expert for formulary and UM recommendations to all segments of the EHP business
ā¢ Respond to physician and member inquiries relating to the prescription drug program
ā¢ Participate in peer-to-peer reviews with EHP Medical Directors and requesting physicians
ā¢ Work in collaboration with the EHP Pharmacy Director to design and implement EHP programs for best practices
ā¢ Create educational lectures and materials for EHP members and staff
ā¢ Generate cost-utilization reports on a regular basis and evaluate the impact of targeted formulary initiatives on internal savings
ā¢ Maintain a database for all utilization management approvals and denials
ā¢ Partner across Cleveland Clinic Pharmacy Enterprise teams and provide expertise for interdepartmental meetings
Qualifications
ā¢ Bachelor's degree in Pharmacy or PharmD from an accredited school of Pharmacy
ā¢ Current State licensure as a Registered Pharmacist (RPh)
ā¢ 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
ā¢ Completion of Pharmacy Residency/Fellowship training or equivalent work experience highly desired
ā¢ Prior experience as a UM pharmacist
Physical Requirements
ā¢ Requires the ability to sit and be stationary for prolonged periods of time
ā¢ Normal or corrected vision
ā¢ Manual dexterity sufficient to perform work on a computer
ā¢ Ability to walk to various locations throughout the health system
Personal Protective Equipment
ā¢ Follows standard precautions using personal protective equipment as required
Apply Now
Apply Now
Role Description
The Pharmacy Clinical Coordinator ā 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.
ā¢ Embedded within a multidisciplinary team of pharmacists and pharmacy technicians
ā¢ Works closely with UM pharmacists who manage referral queues and conduct initial clinical reviews of prior authorizations
ā¢ Routes cases to medical directors when needed
ā¢ Supports formulary and utilization management programs
ā¢ Assists with referral processing and learning appeals that advance to committee review
ā¢ Cross-trained across related functional areas, including formulary management and coordinated care
ā¢ Gains exposure to policy development, coverage criteria, and member education
ā¢ 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:
ā¢ Provide formulary and utilization management (UM) strategy to support the internal EHP Pharmacy and Therapeutics (P&T) committee
ā¢ Review pharmacy benefit prior authorization, step therapy, and formulary exception requests
ā¢ Develop and update pharmacy formulary criteria relating to therapeutic drug classes and individual medications covered under the pharmacy and medical benefits
ā¢ Serve as subject matter expert for formulary and UM recommendations to all segments of the EHP business
ā¢ Respond to physician and member inquiries relating to the prescription drug program
ā¢ Participate in peer-to-peer reviews with EHP Medical Directors and requesting physicians
ā¢ Work in collaboration with the EHP Pharmacy Director to design and implement EHP programs for best practices
ā¢ Create educational lectures and materials for EHP members and staff
ā¢ Generate cost-utilization reports on a regular basis and evaluate the impact of targeted formulary initiatives on internal savings
ā¢ Maintain a database for all utilization management approvals and denials
ā¢ Partner across Cleveland Clinic Pharmacy Enterprise teams and provide expertise for interdepartmental meetings
Qualifications
ā¢ Bachelor's degree in Pharmacy or PharmD from an accredited school of Pharmacy
ā¢ Current State licensure as a Registered Pharmacist (RPh)
ā¢ 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
ā¢ Completion of Pharmacy Residency/Fellowship training or equivalent work experience highly desired
ā¢ Prior experience as a UM pharmacist
Physical Requirements
ā¢ Requires the ability to sit and be stationary for prolonged periods of time
ā¢ Normal or corrected vision
ā¢ Manual dexterity sufficient to perform work on a computer
ā¢ Ability to walk to various locations throughout the health system
Personal Protective Equipment
ā¢ Follows standard precautions using personal protective equipment as required
Apply Now
Apply Now