Responsibilities:

• Provides formulary and utilization management (UM) strategy to support the internal EHP Pharmacy and Therapeutics (P&T) committee and mission of the Cleveland Clinic.
• Reviews pharmacy benefit prior authorization, step therapy, and formulary exception requests.
• Develops and updates pharmacy formulary criteria relating to therapeutic drug classes and individual medications covered under the pharmacy and medical benefits.
• Serves as subject matter expert for formulary and UM recommendations to all segments of the EHP business.
• Responds to physician and member inquiries relating to the prescription drug program.
• Participates in peer-to-peer reviews with EHP Medical Directors and requesting physicians. In collaboration with the EHP Pharmacy Director, proactively designs and implements EHP programs for best practices (e.g., Adherence initiatives, generic conversion initiatives, medication reimbursement, etc.).
• Creates educational lectures and materials for EHP members and staff.
• Generates cost-utilization reports on a regular basis and evaluates impact of targeted formulary initiatives on internal savings.
• Maintains a database for all utilization management approvals and denials.
• Partners across Cleveland Clinic Pharmacy Enterprise teams and provides expertise for interdepartmental meetings.
• Other duties as assigned.

Education:

• Bachelor’s degree in Pharmacy or PharmD from an accredited school of Pharmacy.
• Completion of Pharmacy Residency/Fellowship training or equivalent work experience highly desired.

?

Certifications:

• Current State licensure as a Registered Pharmacist (RPh).

Complexity of Work:

• Within scope of job, requires critical thinking skills, decisive judgment and the ability to work with minimal supervision.
• Must be able to work in a stressful environment.

Work Experience:

• Two years of clinical pharmacy experience or one year of managed care pharmacy experience required.
• Completion of a Pharmacy Residency or Fellowship may offset the required experience.

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.