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Medication Access Specialist

2 months ago

Rockford, United States UW Health in Northern Illinois Full time
At UW Health in northern Illinois, you will have:
•Competitive pay and comprehensive benefits package including: PTO, Medical, Dental, Vision, retirement, short and long-term disability, paternity leave, adoption assistance, tuition assistance
•Annual wellness reimbursement
•Opportunity for on-site day care through UW Health Kids
•Tuition reimbursement for career advancementask about our fully funded programs
•Abundant career growth opportunities to nurture professional development
•Strong shared governance structure
•Commitment to employee voice

POSITION SUMMARY:

The Inpatient Medication Access Specialist is a position residing in the Pharmacy Department. Under the guidance of the Retail Pharmacy Manager, this position is responsible for completing the necessary functions to improve transitions of care for inpatient admissions at discharge by supporting the functions of inpatient and outpatient pharmacists. The Inpatient Medication Access Specialist will proactively identify potential patients who may benefit from SwedishAmerican Hospital (SAH) retail pharmacy services and the med-to-bed program in addition to working with inpatient and outpatient pharmacists who identify potential patients.

The Inpatient Medication Access Specialist is primarily responsible for the following tasks: identifying and educating patients on SAH retail pharmacy services and the med-to-bed program, assessing patients' vaccine status, verifying patients' drug benefit information, processing test claims, applying for federal, governmental and/or private sector grants or patient assistance programs and conducting and completing any necessary prior authorization requests, adjudicating pharmacy claims, procuring payment, and delivery of medications to the bedside. The Inpatient Medication Access Specialist will also be responsible for other duties as assigned.

AGE SPECIFIC CARE:

The Inpatient Medication Access Specialist may work with patients of all age populations.

EDUCATION/TRAINING:

The Inpatient Medication Access Specialist may work with patients of all age populations.

LICENSURE/CERTIFICATION:

Current Pharmacy Technician licensure from State of Illinois or license eligible.

EXPERIENCE/SKILLS/ABILITIES:

Knowledge of medication reimbursement. Knowledge of healthcare insurance prior authorization/coding. Knowledge of and ability to use computers and a variety of computer programs including word processing, database management and spreadsheets. Strong oral and written communications skills. Ability to effectively manage conflicts and resolve problems. Effective interpersonal skills, including the ability to promote collaborative alliances, promote teamwork and ensure a high degree of internal and external customer satisfaction. Ability to function effectively in a fast-paced and changing environment with multiple priorities and careful attention to detail. Knowledge of and ability to perform insurance carrier/managed care review.

ESSENTIAL FUNCTIONS:
  1. Proactively identify potential patients with the utilization of the targeted medication report
      1. Potential patients are also identified from referrals from pharmacists and other care providers that request to use the Inpatient Medication Access Specialist services
  1. Attend daily interdisciplinary rounds to discuss medication-related discharge issues and gather information on planned patient discharge times between 10:30 and 11:15 Monday through Friday
  1. Meet with patients and/or families to market and educate potential patients on the existence and value of SAH retail pharmacy in providing services at and following discharge
    1. Explain the discharge medication/prescription process to patients and discuss the role of the inpatient and outpatient pharmacists in providing safe and efficient discharge care
    2. Educate patients on the service and convenience provided by the SAH outpatient pharmacy upon discharge, and encourage patients to utilize these services
    3. When prompted, provide information to the patient on the process for transferring prescriptions between UW Health pharmacies and the patient's preferred retail pharmacy
    4. For patients expressing interest in filling prescriptions at the SAH outpatient pharmacy at discharge, proactively obtain insurance information from patients and/or family and document in retail pharmacy computer system
    5. Explain that patient and/or family will be responsible for the copayment as determined by the drug benefit plan similar to any other retail pharmacy
    6. Assess the vaccine status of the patient and offer if necessary
      1. Advise clinical pharmacist if patient request a vaccine(s)
    7. Determine if patient will need refills on any prior to admission medications and communicate this information to the inpatient clinical pharmacist
  1. Process test claims for potential discharge medications for patients when appropriate and as requested by inpatient pharmacists and other care providers. Advise patient and/or patient's family, pharmacist, or other care provider of coverage and copayment
  1. Initiate and facilitate the prior authorization process, if required. Effectively and independently coordinate applications for federal, governmental and/or private sector grants or patient assistance programs, if required
  1. Obtain prescription(s), prepare medication(s), and have medication(s) verified by a pharmacist for patients using the med-to-bed program
  1. Adjudicate pharmacy claims with the retail pharmacy computer system for patients using the med-to-bed program
  1. Deliver medications directly to the patient and offer patient counseling by a pharmacist
    1. If counseling if requested, notify the inpatient clinical pharmacist
  1. Procure payment from patient and/or patient's family
  1. Assist with the development and implementation of policies and procedures to ensure a seamless medication-related discharge process for patients
  1. Provide education and training for inpatient pharmacists on insurance-related issues and the tools/resources that are available to address these issues
    1. Educate new pharmacists on the discharge process, providing information on discharge express, commonly encountered insurance-related issues, and tools and resources that are available when medication-related problems are encountered at discharge
    2. Attend and participate in staff meetings