Coordinator Pharmacy Benefit

Cleveland Clinic

6d•Remote

About The Position

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.

Requirements

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

Nice To Haves

Prior authorization experience

Responsibilities

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.