[Hiring] Pharmacy Clinical Coordinator - UM Specialist, EHP @Cleveland Clinic
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.
• Work closely with UM pharmacists who manage referral queues, conduct initial clinical reviews of prior authorizations, and route cases to medical directors when needed.
• Support formulary and utilization management programs.
• Assist with referral processing and learning appeals that advance to committee review, including more in-depth clinical cases.
• Cross-trained across related functional areas, including formulary management and coordinated care.
• Gain exposure to policy development, coverage criteria, and member education while contributing to efficient, compliant, and clinically appropriate benefit operations.
• 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 (e.g., Adherence initiatives, generic conversion initiatives, medication reimbursement, etc.).
• 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, and 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.
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.
• Work closely with UM pharmacists who manage referral queues, conduct initial clinical reviews of prior authorizations, and route cases to medical directors when needed.
• Support formulary and utilization management programs.
• Assist with referral processing and learning appeals that advance to committee review, including more in-depth clinical cases.
• Cross-trained across related functional areas, including formulary management and coordinated care.
• Gain exposure to policy development, coverage criteria, and member education while contributing to efficient, compliant, and clinically appropriate benefit operations.
• 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 (e.g., Adherence initiatives, generic conversion initiatives, medication reimbursement, etc.).
• 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, and 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.