****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 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) Preferred qualifications for the ideal future caregiver include: + 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 health system. **Personal Protective Equipment:** + Follows standard precautions using personal protective equipment as required. **Pay Range** Minimum Annual Salary: $112,110.00 Maximum Annual Salary: $170,955.00 The pay range displayed on this job posting reflects the anticipated range for new hires. A successful candidate's actual compensation will be determined after taking factors into consideration such as the candidate's work history, experience, skill set and education. The pay range displayed does not include any applicable pay practices (e.g., shift differentials, overtime, etc.). The pay range does not include the value of Cleveland Clinic's benefits package (e.g., healthcare, dental and vision benefits, retirement savings account contributions, etc.). Cleveland Clinic Health System is pleased to be an equal employment employer: Women / Minorities / Veterans / Individuals with Disabilities