[Hiring] Pharmacy Clinical Coordinator - UM Specialist, EHP @Cleveland Clinic

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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

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