Coordinator Pharmacy Benefit

                    

At Cleveland Clinic Health System, we believe in a better future for healthcare. And each of us is responsible for honoring our commitment to excellence, pushing the boundaries and transforming the patient experience, every day.

                        

We all have the power to help, heal and change lives — beginning with our own. That’s the power of the Cleveland Clinic Health System team, and The Power of Every One.

                                    

Job Title

Coordinator Pharmacy Benefit

                        

Location

Cleveland

                    

Facility

Remote Location

                     

Department

Clinical Integration-EHP-Pharmacy

                      

Job Code

C15025

                     

Shift

Days

                       

Schedule

9:30am-6:00pm

                       

Job Summary

                         

Job Details

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 Coordinator – Pharmacy Benefit supports prior authorization processes for EHP, serving as a key resource for members, providers, and pharmacies on prescription coverage and benefit-related inquiries. This role works closely with pharmacists and providers to review and process authorization requests, finalize referrals, and manage communications, including member and provider education. While not involved in dispensing, the coordinator plays a critical role in ensuring timely access to medications, resolving issues, and providing subject matter expertise on pharmacy benefits. The position offers a collaborative environment with opportunities for growth and involvement in new initiatives.

This is a remote role in Ohio. A caregiver in this position will work Monday through Friday from 9:30am to 6:00pm with the potential flexible scheduling the future. No holidays, weekends or on-call expectations.

A caregiver who excels in this role will: 

• Respond to physician and member inquires relating to the prescription drug program. 

• Enter all benefit override requests into an internal database. 

• Utilize current internal database for pharmacy benefit overrides. 

• Generate appropriate letters and report and other requests. 

• Place manual benefit overrides into external vendor's (PBM) computer system. 

• Comply data and formats this information into the appropriate medium. 

• Interface with external vendor (PBM) to ensure proper benefit coding and resolve escalated issues. 

• Ensure proper prescription drug benefit coding and develops solutions to problems that cannot be resolved internally. 

• Assist the outpatient pharmacy and human resources departments with benefit coverage questions and other copay related issues. 

• Assist with the implementation and management of pharmacy disease management programs. 

• Analyze and process other reports to send out mailings or place phone calls to the appropriate members regarding benefit changes. 

  

Minimum qualifications for the ideal future caregiver include:    

• High School Diploma or GED   

• Knowledge of pharmacy terminology 

• Certified Pharmacy Technician (CPhT) verified through the Pharmacy Technician Certification Board (PTCB) 

• Minimum of six months retail pharmacy experience or Pharmacy Technician certification 

Preferred qualifications for the ideal future caregiver include:   

• Prior authorization experience

Physical Requirements:

• Requires frequent computer entry, sitting, standing and walking.
• Normal or corrected vision, hearing and speech.

Personal Protective Equipment:

• Follows standard precautions using personal protective equipment as required.

                       

The policy of Cleveland Clinic Health System and its system hospitals (Cleveland Clinic Health System) is to provide equal opportunity to all of our caregivers and applicants for employment in our drug free environment. All offers of employment are followed by testing for controlled substances.

Cleveland Clinic Health System administers an influenza prevention program. You will be required to comply wi