Clinical Pharmacy Specialist Health Plan

Job Summary

Managed care pharmacists are responsible for ensuring patient access to appropriate and cost-effective medication therapies. Pharmacists in this role support a variety of services including developing and implementing evidence-based clinical programs and quality-oriented drug management services, instituting practices to ensure patient safety, communicating and collaborating with patients, prescribers, pharmacists, internal and external clients, contributing to the design of pharmacy benefits, managing quality and cost effectiveness, and involvement in the medication distribution process in the managed care setting.

Essential Functions

• Performs day to day clinical pharmacy functions including prior authorization and appeal reviews.

• Uses clinical expertise to make coverage determinations and ensure adherence to prior authorization protocols, formulary status, medical necessity and contract criteria.

• Analyzes pharmacy and medical spend data (total cost of care, drug and medical trends) and coordinates development of appropriate use standards, prior authorization protocols, and guidelines.

• Supports drug formulary development and management.

• Participates in strategies and clinical programs that ensure appropriate and cost-effective medication use, through principles of drug utilization management and medication optimization.

• Works with medical directors, pharmacy leaders, and medical management teams to provide drug information support to promote optimal quality of care and efficient use of resources.

• Participates in clinical and operational process improvement and cost savings opportunities.

• Supports clinical initiatives related to NCQA, HEDIS, CAHPS, STAR measures, and other clinical quality and programs. Adheres to Pharmacy Policies and Procedures.

Qualifications

Required

• Doctorate Doctor of Pharmacy degree from an accredited College of Pharmacy

• LIC-Clinical Pharmacist - STATE_MI State of Michigan Upon Hire or LIC-Clinical Pharmacist - STATE_OTHR State Other than Michigan

Preferred

• 2 years of relevant experience managed care pharmacy experience or completion of a Managed Care Pharmacy Residency

• 2 years of relevant experience Familiarity with the Michigan health care market and provider groups and practices

About Corewell Health

As a team member at Corewell Health, you will play an essential role in delivering personalized health care to our patients, members and our communities. We are committed to cultivating and investing in YOU. Our top-notch teams are comprised of collaborators, leaders and innovators that continue to build on one shared mission statement - to improve health, instill humanity and inspire hope. Join a nationally recognized health system with an ambitious vision of continued advancement and excellence.

How Corewell Health cares for you

• Comprehensive benefits package to meet your financial, health, and work/life balance goals. Learn more here.

• On-demand pay program powered by Payactiv

• Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more!

• Optional identity theft protection, home and auto insurance, pet insurance

• Traditional and Roth retirement options with service contribution and match savings

• Eligibility for benefits is determined by employment type and status

Primary Location

SITE - Priority Health - 1231 E Beltline Ave NE - Grand Rapids

Department Name

Pharmacy Operations - PH Managed Benefits

Employment Type

Full time

Shift

Day (United States of America)

Weekly Scheduled Hours

40

Hours of Work

8:00 a.m. to 5:00 p.m.

Days Worked

Monday to Friday

Weekend Frequency

On-call weekends

CURRENT COREWELL HEALTH TEAM MEMBERS – Please apply through Find Jobs from your Workday team member account. This career site is for Non-Corewell Health team members only.

Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and community. We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in t