Pharmacy Clinical Coordinator - UM Specialist

Join Cleveland Clinic's Pharmacy Team

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 remote 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 for applicants residing in Ohio or Florida. A caregiver in this role will work 8:00am to 5:00pm, with no weekend, holiday, or on-call requirements.

Key Responsibilities for a Pharmacy Clinical Coordinator - UM Specialist

• 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.
• Collaborate with the EHP Pharmacy Director to 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 regularly 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

• 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

• Completion of Pharmacy Residency/Fellowship training or equivalent work experience highly desired.
• Prior experience as a UM pharmacist.

Physical Requirements & Personal Protective Equipment

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. Follows standard precautions using personal protective equipment as required.

Key skills/competency

• Utilization Management (UM)
• Formulary Management
• Prior Authorization Review
• Clinical Pharmacy
• Managed Care Pharmacy
• Drug Benefit Programs
• Pharmacy and Therapeutics (P&T) Committee
• Healthcare Regulations
• Data Analysis (Cost-utilization)
• Member Education