Medication Access Coordinator - Pharmacy Services - Medical Benefit, Infusion & Clinic Administered Meds

McLeod Health • Florence, SC

76d

About The Position

Reporting to the Pharmacy Business Services Corporate Director, the Medication Access Coordinator is responsible for supporting patients’ access to critical medications in a timely and affordable manner. This individual is responsible for the communication of determination outcomes both verbally and electronically with providers, clinical team members, and patients. When an authorization or patient assistance cannot be obtained, the Medication Access Coordinator must be able to guide and educate staff, providers, and/or patients on the options and necessary steps to resolve the barriers to obtaining necessary medications.
Consistently offer a positive patient and healthcare team experience:
Support an exceptional experience through all customer interactions, ensuring professional, timely and accurate communication both verbally and in writing.
Facilitate and establish clinic, pharmacy, and patient relationships conducive to delivering high quality patient care.
Demonstrate the core values of McLeod Health including the Value of Caring, the Value of the Person, the Value of Quality, and the Value of Integrity in every interaction.
Improve patients’ access to medications:
Receive and prioritize referrals to complete medication prior authorizations and/or patient assistance from clinic staff, providers, and pharmacy partners.
Verify third-party payer coverage and medication benefits/coverage policies.
Complete thorough benefits investigations to determine patient third-party payer coverage level and out-of-pocket costs.
Obtain necessary clinical information through investigation and review of the electronic medical record to ensure complete and accurate prior authorization submission, collaborating with the clinic to acquire additional
information or guidance if necessary.
Support clinical staff, providers, and pharmacy partners in the navigation of, and adherence to, internal and external formulary policies, pathways, and step-therapy requirements to ensure appropriate and cost-effective medication use.

Requirements

• Minimum of two years of health system or applicable healthcare related experience, required.
• High school diploma or equivalent, required.

Nice To Haves

• Prior experience working in a specialty or infusion pharmacy setting, particularly in medication access, prior authorization, or patient access programs, preferred.
• Proficiency in Medicare and third-party payer regulations and guidelines.
• Knowledge of CPT and ICD coding, preferred.
• Proficiency in using pharmacy management software, preferred.
• Baccalaureate or advanced degree, preferred.
• Completion of an RN or pharmacy technician training program, preferred.
• Eligible for licensure to practice under applicable discipline in the state of South Carolina, preferred.
• RN or CPhT or ExCPT preferred

Responsibilities

• Support an exceptional experience through all customer interactions, ensuring professional, timely and accurate communication both verbally and in writing.
• Facilitate and establish clinic, pharmacy, and patient relationships conducive to delivering high quality patient care.
• Demonstrate the core values of McLeod Health including the Value of Caring, the Value of the Person, the Value of Quality, and the Value of Integrity in every interaction.
• Receive and prioritize referrals to complete medication prior authorizations and/or patient assistance from clinic staff, providers, and pharmacy partners.
• Verify third-party payer coverage and medication benefits/coverage policies.
• Complete thorough benefits investigations to determine patient third-party payer coverage level and out-of-pocket costs.
• Obtain necessary clinical information through investigation and review of the electronic medical record to ensure complete and accurate prior authorization submission, collaborating with the clinic to acquire additional information or guidance if necessary.
• Support clinical staff, providers, and pharmacy partners in the navigation of, and adherence to, internal and external formulary policies, pathways, and step-therapy requirements to ensure appropriate and cost-effective medication use.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED
• Number of Employees: 5,001-10,000 employees