Pharmacy Analyst - Utilization Management

Henry Ford Health; Troy (MI); On-site; USD 55,000 - 75,000; Full time

Job summary

Henry Ford Health in Detroit (MI) is seeking a Pharmacy Analyst to help resolve drug claim adjudication issues, manage prior authorization, and handle pharmacy benefit inquiries. This role supports members, patients, physicians, pharmacies, and internal teams to ensure seamless medication access.

Ideal candidates have a high school diploma or GED, at least one year of pharmacy experience, solid knowledge of medical and pharmacy terminology, and strong communication and organizational skills to

Qualifications

• Minimum of one year of previous pharmacy experience.
• Strong understanding of medical/clinical and pharmacy terminology.
• Working knowledge of personal computers and Microsoft Office.
• High school diploma or G.E.D. equivalent.
• Organizational and time management skills to prioritize multiple tasks.
• Strong interpersonal communication skills and customer interaction experience.

Responsibilities

• Resolve drug claim adjudication issues and prior authorization requests.
• Handle pharmacy benefit inquiries from members, patients, physicians, and pharmacies.
• Coordinate prior authorization and exception processes as a subject matter expert.
• Ensure accurate and timely resolution of pharmacy benefit coverage issues.
• Collaborate with internal and external stakeholders to provide exceptional service.

Skills

Pharmacy experience

Medical terminology

Interpersonal communication

Time management

Education

High school diploma

Tools

Microsoft Office

Job description

• Full-time
• Job Type: Full Time

Company Description

Henry Ford Health partners with millions of people on their health journey, across Michigan and around the world. We offer a full continuum of services from primary and preventative care to complex and specialty care, health insurance, a full suite of home health offerings, virtual care, pharmacy, eye care and other health care retail. With former Ascension southeast Michigan and Flint region locations now part of our team, Henry Ford's care is available in 13 hospitals and hundreds of ambulatory care locations. Based in Detroit, Henry Ford is one of the nation's most respected academic medical centers and is leading the Future of Health: Detroit, a $3 billion investment anchored by a reimagined Henry Ford academic healthcare campus.

Job Description

Role Overview

As a Pharmacy Analyst, you will be responsible for handling daily pharmacy duties, including drug claim adjudication issues, prior authorization, and pharmacy benefit inquiries. You will act as a subject matter expert in resolving pharmacy benefit coverage issues and coordinating prior authorization and exception processes, supporting members, patients, physicians, pharmacies, and internal teams.

What You Will Do

• Resolve drug claim adjudication issues and prior authorization requests.
• Handle pharmacy benefit inquiries from members, patients, physicians, and pharmacies.
• Coordinate prior authorization and exception processes as a subject matter expert.
• Ensure accurate and timely resolution of pharmacy benefit coverage issues.
• Collaborate with internal and external stakeholders to provide exceptional service.

What We Offer

Join a team where you can grow your career, collaborate with dedicated professionals, and engage in mission-driven work that makes a difference. We provide opportunities for continuous learning and development, empowering you to reach your full potential while contributing to our shared mission of exceptional care.

Qualifications

Required Qualifications

• High school diploma or G.E.D. equivalent.
• Minimum of one year of previous pharmacy experience.
• Strong understanding of medical/clinical and pharmacy terminology.
• Working knowledge of personal computers and Microsoft Office.
• Organizational and time management skills to prioritize multiple tasks.
• Strong interpersonal communication skills and customer interaction experience.

Preferred Qualifications

• State of Michigan Pharmacy Technician licensure.