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 - STATEMI State of Michigan Upon Hire or LIC-Clinical Pharmacist - STATEOTHR 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

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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 the job application process to perform the essential functions of a job or to enjoy equal benefits and privileges of employment due to a disability pregnancy or sincerely held religious belief.

Corewell Health grants equal employment opportunity to all qualified persons without regard to race color national origin sex disability age religion genetic information marital status height weight gender pregnancy sexual orientation gender identity or expression veteran status or any other legally protected category.

An interconnected collaborative culture where all are encouraged to bring their whole selves to work is vital to the health of our organization. As a health system we advocate for equity as we care for our patients our communities and each other. From workshops that develop cultural intelligence to our inclusion resource groups for people to find community and empowerment at work we are dedicated to ongoing resources that advance our values of diversity equity and inclusion in all that we do. We invite those that share in our commitment to join our team.

You may request assistance in completing the application process by calling 616.486.7447.