Clinical Pharmacy Specialist Priority Health

Spectrum Health; Grand Rapids (MI); On-site; USD 110,000 - 150,000; Full time

Benefits offered by this job

Comprehensive benefits package

On-demand pay program (Payactiv)

Discounts directory

Job summary

Corewell Health in Grand Rapids is seeking a pharmacist to support managed care programs, ensure cost-effective therapies, and collaborate with prescribers and care teams. The role includes developing clinical programs, supporting formulary management, and participating in quality initiatives.

You will handle day-to-day clinical functions such as prior authorization, data analysis for spend trends, and adherence to program protocols, while maintaining patient safety and compliance with policies.

Qualifications

• Doctorate Doctor of Pharmacy from an accredited College of Pharmacy.
• LIC-Clinical Pharmacist - STATE_MI Upon Hire.
• LIC-Clinical Pharmacist - STATE_OTHR Upon Hire.

Responsibilities

• 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.
• Analyses pharmacy and medical spend data and coordinates development of appropriate use standards and guidelines.
• Supports drug formulary development and management.
• Participates in strategies and clinical programs that ensure appropriate and cost-effective medication use.

Education

Doctorate Doctor of Pharmacy

LIC-Clinical Pharmacist - STATE_MI

LIC-Clinical Pharmacist - STATE_OTHR

Job description

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

• Doctorate Doctor of Pharmacy degree from an accredited College of Pharmacy
• LIC-Clinical Pharmacist - STATE_MI State of Michigan Upon Hire
• LIC-Clinical Pharmacist - STATE_OTHR State Other than Michigan Upon Hire

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

Benefits

• How Corewell Health cares for you Comprehensive benefits package to meet your financial, health, and work/life balance goals.
• 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
• Traditional and Roth retirement options with service contribution and match savings
• Eligibility for benefits is determined by employment type and status

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.

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 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.

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.

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.

People are at the heart of everything we do, and the inspiration for our legacy of outstanding outcomes, innovation, strong community partnerships, philanthropy and transparency. Corewell Health is a not-for-profit health system that provides health care and coverage with an exceptional team of 60,000+ dedicated people—including more than 11,500 physicians and advanced practice providers and more than 15,000 nurses providing care and services in 22 hospitals, 300+ outpatient locations and several post-acute facilities—and Priority Health, a provider-sponsored health plan serving more than 1.2 million members. Through experience and collaboration, we are reimagining a better, more equitable model of health and wellness.

Work Location and Employment

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 a.m. to 5 p.m. Days Worked Monday to Friday Weekend Frequency On-call weekends

We invite those that share in our commitment to join our team.