[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 – 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 Apply Now Apply Now