Program Integrity Director Jobs in Kentucky (NOW HIRING)

Under the general direction of the Retail Pharmacy Manager/Outpatient Pharmacist In Charge, the Outpatient/Ambulatory Care Pharmacist is responsible for the assistance in the coordination and direction of the Outpatient Pharmacy Services provided from the Retail Pharmacy. The Outpatient/Ambulatory Care Pharmacist provides direct patient care services in the form of dispensed prescriptions, patient counseling about their prescriptions, drug regimen review, disease management, patient education appointments, immunizations, educational presentations, and assistance with coordination and administration of Pharmacy benefits. The Outpatient/Ambulatory Care Pharmacist develops patient programming and community relations events that meet the scope of service as defined by mutually defined goals of Ephraim McDowell Health leadership. The Outpatient/Ambulatory Care Pharmacist shall assist in the clinical policy and procedure development, evaluation and maintenance of software databases, Patient Accounting and register deposits, 3rd party contracts and claims processing, operation of computers, supervision of Technicians, Precepting of Students or Residents and customer service. The Outpatient/Ambulatory Care Pharmacist maintains appropriate patient record documentation for clinical and distributive services provided. The Outpatient/Ambulatory Care Pharmacist collaborates and coordinates safe transition of care to or from the hospital with patient, caregivers, other institutions, providers and Pharmacies. The Outpatient/Ambulatory Care Pharmacist adheres to best practices for medication safety. The Outpatient/Ambulatory Care Pharmacist is responsible for inventory management functions and 340b program integrity. The Outpatient/Ambulatory Care Pharmacist exhibits the F.I.R.S.T. values (Friendliness, Innovation, Respect, Service, and Trust).
ESSENTIAL FUNCTIONS, DUTIES AND RESPONSIBILITIES:

1. The Outpatient/Ambulatory Care Pharmacist will work with the Retail Manager to develop, initiate and maintain Pharmacy goals and management initiatives, including Pharmacy Benefits Management for Associates.
2. Serves as Preceptor for Pharmacy Students or Residents. Offers Pharmacy Tech or Pharm.D. Students assigned to the department a clinical experience in provision of Outpatient and Ambulatory Care Pharmacy services.
3. Considers the age of the patients served, applies knowledge of growth and development and age-specific techniques over the life span in planning and implementing care.
4. The Outpatient/Ambulatory Care Pharmacist obtains patient information to create and maintain a Pharmacy profile for each patient. This includes current address, date of birth, medical conditions, height, weight, other prescription or non-prescription medications or supplements the patient is currently taking, medication or environmental allergies, physician. The patient's social security number or insurance information may be requested if necessary for processing or billing the prescription.
5. The Outpatient/Ambulatory Care Pharmacist accurately processes the prescriptions received. This includes accurate interpretation and entry of the prescription information into the McKesson computer, screening for interactions, documentation of clarifications or interventions performed, accurate billing, automated or manually dispensing the prescribed product.
6. The Outpatient/Ambulatory Care Pharmacist maintains controlled substance inventory records and reconciles with invoices for products purchased or removed from inventory. Reports unresolved discrepancies (+/- 5%) to Retail Manager. The Outpatient/Ambulatory Care Pharmacist provides DEA 222 forms or CSOS orders as required for ordering or transfer of controlled meds. The Outpatient/Ambulatory Care Pharmacist assures adequate security of controlled substances and adheres to regulations for reporting controlled substance dispensing to KASPER.
7. The Outpatient/Ambulatory Care Pharmacist provides patient counseling, drug information to patients, professional staff and the public, medication regimen consults, continuous quality improvement, and drug utilization reviews.
8. The Outpatient/Ambulatory Care Pharmacist assists Retail Manager as a resource and EMH Representative for Health Fairs and community education opportunities.
9. The Outpatient/Ambulatory Care Pharmacist contacts prescribing Practitioner to verify prescriptions which are incomplete, illegible, pose a risk of adverse interaction with prescribed medications, or of questionable validity. The Outpatient/Ambulatory Care Pharmacist adheres to evidence based and best practice standards to assure patient safety. (Ex. Barcode scanning of product being dispensed).
10. The Outpatient/Ambulatory Care Pharmacist reports any fraudulent prescriptions to local authorities and Retail Manager. May be asked to assist in providing information for prosecution of crimes related to such events.
11. The Outpatient/Ambulatory Care Pharmacist verifies and signs dispensing records daily. Maintains prescription files and dispensing records in an orderly fashion.
12. The Outpatient/Ambulatory Care Pharmacist contributes to the effective operations of the EMH Organization by demonstrating dependability in job performance. The Outpatient/Ambulatory Care Pharmacist provides a positive role model for other Pharmacy and EMH Associates.
13. The Outpatient/Ambulatory Care Pharmacist contributes to the achievement of the mission and philosophy of the Organization. The Outpatient/Ambulatory Care Pharmacist supports the Organizational goals and initiatives.
14. The Outpatient/Ambulatory Care Pharmacist demonstrates commitment to professional accountability and growth to maintain and expand knowledge and skills.
15. The Outpatient/Ambulatory Care Pharmacist oversees appropriate billing of patients for medications used. Includes online adjudication of electronic claims, submitting payroll deduction statements for Associates, processing monthly patient account bills, submitting monthly charges for indigent, Hope Clinic and Foundation eligible patients. Oversees and complies with policies for patient and prescription eligibility for the 340b program to maintain program integrity.
16. Demonstrates willingness to coordinate continuity of care and work on joint clinical and transition of care projects with EMRMC Associates.
17. Associate is trained and is proficient in DME specific sales and billing.
18. The Outpatient/Ambulatory Care Pharmacist interprets and adjusts medication regimens based on interpretation of clinical data and patient clinical condition to effectively and safely manage patient's medical conditions (per collaborative care or ambulatory care protocols). Appropriately documents clinical interventions in the medical record and communicates medication action plan to Physician or referring Provider.
19. Proficient in completing online MTM Comprehensive Medication Reviews and TIPs through Humana Outcomes and Mirixa.
20. The outpatient/Ambulatory Care Pharmacist administers vaccines per protocol.