Ambulatory Medication Access/Referral Coordinator

Overview Department: Ambulatory Pharmacy Schedule: Full Time Days Mon-Fri 8a-5p Facility: Prime Healthcare St Francis Hospital Location: Evanston, IL 60201 Responsibilities The Ambulatory Medication Access and Referral Coordinator provides expert-level support to the Prime Healthcare Ambulatory Services Team. This support will span all advanced complex aspects of ambulatory pharmacy workflows including, but not limited to, referral review and processing, patient scheduling, maintaining accurate data records of activities and outcomes, and evaluating patient’s insurance to assist with medication access. The position participates in implementing medication access workflows for newly established ambulatory pharmacy service departments and validating maintenance of medication access workflows at existing ambulatory pharmacy service departments. This position serves as a liaison between providers, pharmacies, insurance carriers, and patients to streamline medication access, reduce financial barriers, and support continuity of care This position independently manages and strategically evaluates patient referrals for Ambulatory Care services to determine appropriateness of referral, collaborates with referring provider(s) for information clarifications, and conducts patient outreach and interviews to obtain additional information and scheduling, as appropriate. The Ambulatory Medication Access and Referral Coordinator is also responsible for maintaining accurate records within the electronic medical record (EMR) of all activities performed to ensure excellent coordination of care. The Ambulatory Medication Access and Referral Coordinator must have comprehensive expertise in prior authorization management, including expertise with all insurance types, specialty medication access, and financial assistance coordination within ambulatory care settings. This position must be proficient with the requirements of the 340b program and ensure all prescriptions are going through the necessary steps to qualify for this program. The Ambulatory Medication Access and Referral Coordinator must be knowledgeable on financial assistance including pharmaceutical foundation programs, manufacturer copay assistance cards, and internal medication assistance processes. Depending on the acuity of medication access or referrals, the coordinator will also review each case with the Ambulatory Pharmacy Technician Supervisor or overseeing pharmacist, as appropriate, to avoid gaps in care. This position serves as a subject matter expert and uses independent discretion and judgement in prioritizing their workflow, managing patient problems, and ensuring all patients receive their medications in a timely manner. This position ensures proper, efficient insurance authorization, answers financial questions from patients and providers, and documents authorization outcomes to guide optimal, timely medication access. This position manages uninsured and underinsured patient referrals to ensure enrollment in patient assistance and other charity options as available. This position serves as a subject matter expert and key operational resource to clinical leadership, providers, and prior authorization coordinators. Qualifications EDUCATION, EXPERIENCE, TRAINING Required qualifications: High school diploma or equivalent required Current State of IL pharmacy technician license in good standing Certified Pharmacy Technician (CPhT) credential Minimum 3 years of experience in ambulatory care, specialty pharmacy, or 340B settings Proficiency in electronic medical record (EMR) systems and insurance authorization platforms. Knowledge of HIPAA regulations and patient confidentiality standards. Preferred qualification: Working knowledge of pharmaceutical foundation assistance programs and manufacturer co-pay card enrollment processes. Experience qualifying and processing patients under 340B drug pricing program guidelines. Strong understanding of commercial, Medicare, and Medicaid insurance plans and formulary requirements. Experience coordinating patient outreach and scheduling in a high-volume clinical setting Excellent communication skills with the ability to collaborate effectively with providers, pharmacies, payers, patients, and external offices. Strong organizational skills with the ability to manage multiple cases and meet deadlines in a fast-paced environment. Experience with specialty pharmacy Pay Transparency Saint Francis Hospital offers competitive compensation and a comprehensive benefits package that provides employees the flexibility to tailor benefits according to their individual needs. Our Total Rewards package includes, but is not limited to, paid time off, a 401K retirement plan, medical, dental, and vision coverage, tuition reimbursement, and many more voluntary benefit options. A reasonable compensation estimate for this role, which includes estimated wages, benefits, and other forms of compensation, is $23.00 to $32.68 on an hourly basis. The exact starting compensation to be offered will be determined at the time of selecting an applicant for hire, in which a wide range of factors will be considered, including but not limited to, skillset, years of applicable experience, education, credentials and licensure. The company is dedicated to empowering its staff with a comprehensive, competitive benefits package, allowing them the freedom to customize their benefits to fit their unique needs. Our abundant resources, programs, and voluntary options serve as a foundation for individual growth and well-being. Learn more here: Employment Status Full Time Shift Days Equal Employment Opportunity Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: #J-18808-Ljbffr Prime Healthcare