Managed Care Clinical Pharmacist — Cost & Quality Impact

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

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.