Remote Prior Authorization Rn Jobs in Florence, SC

Medication Access Coordinator - McLeod Pharmacy Services - Medical Benefit & Infusion

Job Summary

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.

Key Responsibilities:

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.

• Collaborate with key stakeholders in the medication use process and identify and recommend alternate sites of care delivery when appropriate to ensure payment for services.

• Document and communicate updates and final determinations to patients, providers, and pharmacies in a timely and accurate manner.

• Notify clinical staff of additional requested information from payor regarding medication. authorizations to reduce approval delays (i.e., Peer to peer, letter of medical necessity, document signatures).

• Identify alternate sources of funding or medication supply when required to facilitate patient access to appropriate therapies to prevent unnecessary healthcare utilization. 

Work Schedule: 80 Hours Biweekly. Full Time

Miscellaneous: 

• Participate in training and onboarding of new Medication Access Team members 
  • Other duties, as assigned

Qualifications /Training:

• Minimum of two years of health system or applicable healthcare related experience, required.

  • 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.

Licenses/Certifications/Registrations/Education:

• High school diploma or equivalent, required.

  • 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.

Founded in 1906, McLeod Health is a locally owned and managed, not for profit organization supported by the strength of more than 900 members on its medical staff and more than 2,900 licensed nurses. McLeod Health is also composed of approximately 15,000 team members and more than 90 physician practices throughout its 18-county service area. With seven hospitals, McLeod Health operates three Health and Fitness Centers, a Sports Medicine and Outpatient Rehabilitation Center, Hospice and Home Health Services. The system currently has 988 licensed beds, including Hospice and Behavioral Health. The hospitals within McLeod Health include: McLeod Regional Medical Center, McLeod Health Dillon, McLeod Health Loris, McLeod Health Seacoast, McLeod Health Cheraw, McLeod Health Clarendon and McLeod Behavioral Health.