At Cleveland Clinic Health System, we believe in a better future for healthcare. And each of us is responsible for honoring our commitment to excellence, pushing the boundaries and transforming the patient experience, every day.

                        

We all have the power to help, heal and change lives — beginning with our own. That’s the power of the Cleveland Clinic Health System team, and The Power of Every One.

                                    

Job TitlePharmacy Clinical Coordinator - UM Specialist, EHP

                        

LocationCleveland

                    

FacilityRemote Location

                     

DepartmentClinical Integration-EHP-Pharmacy

                      

Job CodeT99330

                     

ShiftDays

                       

Schedule8:00am-5:00pm

                       

Job Summary

                         

Job Details

**Applicants must reside in Ohio or Florida

Join the Cleveland Clinic team where you will work alongside passionate caregivers and provide patient-first healthcare. Here, you will receive endless support and appreciation while building a rewarding career with one of the most respected healthcare organizations in the world. 

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, this role works closely with UM pharmacists who manage referral queues, conduct initial clinical reviews of prior authorizations and route cases to medical directors when needed. Responsibilities include supporting formulary and utilization management programs, assisting with referral processing and learning appeals that advance to committee review, including more in-depth clinical cases. The coordinator is cross-trained across related functional areas, including formulary management and coordinated care, gaining exposure to policy development, coverage criteria and member education while contributing 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 and mission of the Cleveland Clinic.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. Will work in collaboration with the EHP Pharmacy Director, proactively 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 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.

Minimum qualifications for the ideal future caregiver include:

Bachelor's degree in Pharmacy or PharmD from an accredited school of PharmacyCurrent 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)

Preferred qualifications for the ideal future caregiver include:

Completion of Pharmacy Residency/Fellowship training or equivalent work experience highly desiredPrior 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 health system.

Personal Protective Equipment:

Follows standard precautions using personal protective equipment as required. 

                       

The policy of Cleveland Clinic Health System and its system hospitals (Cleveland Clinic Health System) is to provide equal opportunity to all of our caregivers and applicants for employment in our drug free environment. All offers of employment are followed by testing for controlled substances.

Cleveland Clinic Health System administers an influenza prevention program. You will be required to comply with this program, which will include obtaining an influenza vaccination on an annual basis or obtaining an approved exemption.

Decisions concerning employment, transfers and promotions are made upon the basis of the best qualified candidate without regard to color, race, religion, national origin, age, sex, sexual orientation, marital status, ancestry, status as a disabled or Vietnam era veteran or any other characteristic protected by law. Information provided on this application may be shared with any Cleveland Clinic Health System facility. 

Please review the Equal Employment Opportunity poster. 

                  

Cleveland Clinic Health System is pleased to be an equal employment employer: Women / Minorities / Veterans / Individuals with Disabilities