University of Rochester Medication Access Specialist - SMH Specialty Pharmacy - 227393 in Rochester, New York
Medication Access Specialist - SMH Specialty Pharmacy Job ID 227393Location Strong Memorial Hospital Full/Part Time Full-Time Favorite Job Regular/Temporary Regular Opening
Full Time 40 hours Grade 008 Pharmacy SMH - Specialty PharmacySchedule
Monday - Friday; Days
SMH Specialty PharmacyResponsibilities
The Medication Access Specialist (MAS) is responsible for the overall management of drug access for high-cost specialty medications. Duties will include collaboration with clinical staff to acquire prior authorization for relevant providers, benefit investigation, patient assistance program enrollment, and ensuring timely delivery of the specialty medication. The MAS will serve as a liaison between the patient, pharmacist, insurance, and clinic staff to ensure excellent, coordinated care and service.
The MAS has independent responsibility for organizing and planning work in order to accomplish daily work requirements. Duties of this position requires proper judgement, sensitivity, and strict adherence to Strong Memorial Hospital policy on confidentiality and the protection of Private Health Information. The MAS interacts with multiple individuals internal and external to the institution including, but not limited to, hospital and cli nical employees at multiple levels including pharmacists, pharmacy technicians, medical/clinical staff, central prior authorization staff. External contacts include third party payors, governmental peer review organizations , and referring physicians. To be effective this individual must be able to establish strong collaborative working relationships.
SPECIFIC RESPONSIBILITIES: (Approximate time spent %)
Pharmacy Coordination (50%)
As part of the patient intake process, the MAS will conduct a benefits investigation for high-cost, specialty drugs and will be able to discuss the patient obligation for treatment with the patient and/or family.
Provide excellent customer service through the Specialty Pharmacy Call Center. Triage patient calls to appropriate party. Answer incoming calls in a timely manner.
Expedite clinic workflow and enhance patient care by preventing therapy interruptions due to insurance issues in conjunction with pharmacists, physicians, and clinic staff.
Make scheduled calls to patient to process prescriptions and set up deliveries. Facilitate adherence to medications by ensuring that patients receive prescribed medications in a timely manner.
Document and triage patient problems with therapy to the appropriate pharmacist; ensure documentation of problem, follow-up with patient and assist with coordination of filling, packaging and delivery of prescriptions.
Manage inventory of clinic medications and communicate with inventory manager to notify what to order. The MAS will also track changes in prescribing trends to alert inventory manager if changes in stock on hand is needed
Review and report status of patient charge accounts once monthly by the first week of each month for previous month
Patient Assistance Program Management (20%)
The MAS will be highly knowledgeable and will remain up-to-date on all potential patient assistance programs (PAP) relevant to the high-cost, specialty drugs prescribed in the assigned clinic(s).
The MAS will prospectively evaluate every patient receiving high-cost, specialty drug therapy for potential participation in PAPs, and identify the best option(s) for the patient given their overall circumstances (insurance, disease state, income, etc). This will often involve communicating with the patient and/or family to obtain necessary information which may include income information and other personal details, as well as to present PAP options to the patient/family when there are multiple options.
The MAS will enroll patients in PAPs using the mechanisms that are required for each program, and will follow-through to assure the PAP is approved and properly documented in the electronic medical record.
The MAS will submit all required documentation to the PAP throughout the duration of treatment to assure payment for each prescription dispensed, as well as assure continued coverage for the maximum amount of assistance available.
As needed, the MAS will meet or discuss with the patient and/or family the status of PAP eligibility if things change during care.
The MAS will serve as a general resource available to patients, providers and other clinic staff about PAPs.
The MAS is responsible for understanding and managing the payment process specific to each PAP, and assures that payments are properly applied to the correct patient and correct patient encounter.
Facilitate enrollment of patients in PAPs and collaborate with social services and case management on patient assistance. Assist pharmacists with preparing letters of medical necessity and coordinating peer-to-peer conferences.
Prior Authorization Management (20%)
The MAS will be highly knowledgeable of the current policies of the major payors for the relevant clinic-administered drugs that require prior authorization (PA), and will be responsible for working with the prior authorization coordinators, office staff nurses and other patient care staff to assure that all required elements of the policy are applicable in advance of requesting PA.
Improve patient service experience through provision of prior authorization services on behalf of clinics for specialty medications. Complete prior authorization forms, negotiate authorization status with insurers, track status of prescription approval, and when necessary, alert clinical pharmacists of denials or nonresponse.
If a letter of medical necessity or physician-to-medical director conversation is needed for approval outside of the payor policy, the MAS will notify the relevant provider and provide the physician with needed documentation and summary of actions taken to date.
The MAS will document all PAs in the appropriate location within the electronic medical record include the PA number and dates of approval.
The MAS will track all PAs to assure that they are renewed on a timely basis to prevent interruptions or delays in treatment.
Compliance and quality (10%)
In all interactions with staff and patients/families the MAS will be professional, courteous and diligent
Patient satisfaction with the work of the MAS, the PAP, and overall drug management process will be high. The pharmacy completes a provider and customer satisfaction survey annually to assess.
Report errors through hospital error reporting system (RL solutions) and contribute to quality improvement initiative
Assist with prescription audits and ensuring patients return signature logs
Facilitate staff training and competency, education and practice advancement
Performs other related duties as required.
Associate’s degree in Medical, Secretarial or related field or certified pharmacy technician (CPhT) and a minimum of three years of relevant experience required; or an equivalent combination of education and experience. Must be capable of working independently with minimum supervision. Strong communication skills, problem-solving abilities, and a professional presentation are essential and required. Medical terminology, experiences with medical/surgical scheduling software, and electronic medical records preferred. Demonstrated customer relations skills.
NOTE: This document describes typical duties and responsibilities and is not intended to limit management from assigning other work as required.How To Apply
All applicants must apply online.
EOE Minorities/Females/Protected Veterans/Disabled