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As a patient-centered organization, UCSF Medical Center exists to enhance the health and well-being of people through patient care, research and education. Success in this mission requires a culture of collaboration, excellence, leadership and respect. UCSF Medical Center seeks faculty and staff that are committed to the values of professionalism, respect, integrity, diversity and excellence that are integral to our mission

Under the supervision of the Medication Access Manager and guided by the policies and procedures of the Ambulatory and Outpatient Pharmacy Services, the Pharmacy Medication Support Specialist (MSS) facilitates prescription prior authorization (PA) and refill requests This role involves obtaining, preparing and submitting the necessary forms  for insurance authorizations, requesting information from insurance companies regarding possible alternative therapies, and providing patients with timely communications regarding the status of the PA.  In addition, this position is also responsible in facilitating medication refills requests. Using a refill protocol, the MSS evaluates refill requests for adherence to the refill protocol criteria which includes reviewing a patient's medical record in APeX and contacting a patient for needed information. The MSS also performs medication benefits investigations and explores financial assistance options where applicable, to ensure patients have access to the medication they need, acting as the primary contact for all medication authorization and refill requests.
 

 REQUIRED QUALIFICATIONS

• This position requires flexibility to orient and work at all UCSF Medical Center locations.
• Completion of a recognized/accredited Pharmacy Technician Training Program.
• Minimum three (3) years' experience as a Pharmacy Technician or allied healthcare professional in a hospital, pharmacy, or other health care setting, or equivalent combination of education and experience.
• Strong computer skills and use of Microsoft Office
• Ability to prioritize work efficiently
• Excellent interpersonal communication skills, writing skills, and ability to work effectively with a large, diverse population, including maintaining good relationships between the Pharmacy and Ambulatory clinics.
• Excellent organizational and problem-solving skills
• Must be able to multitask and be flexible in changing work assignments at short notice

• Basic math skills

PREFERRED QUALIFICATION
  

• Recent experience processing third-party billing, including prior authorization facilitation and refill authorization
•   Bilingual in Spanish, Cantonese, and/or Russian preferred
•   Bachelor's degree in health or behavioral science.
•  Medical Assistant Certification 
• Ability to use EMR and perform chart abstraction into EMR - specifically APeX

• Adaptable to learn new technologies including AI solutions.

REQUIRED LICENSES/CERTIFICATIONS

    Licensed Pharmacy Technician by the California Board of Pharmacy and in good standing 
 

DUTIES & ESSENTIAL JOB FUNCTIONS

%  

of time

Essential Function (Yes/No)

Key Responsibilities

(To be completed by Supervisor)

45

Prior Authorization (PA) and Financial Assistance Facilitation

• Under the oversight of pharmacists, drives the Prior Authorization (PA) process to completion and resolves any related issues.
• Performs medication benefits investigation and accurately submits prior authorizations to insurance manually, electronically, or telephonically as necessary
• Notifies the patient and documents the status of the PA and financial assistance in APeX
• Follows up with health insurance payors that don't respond to submitted PA requests
• Works with pharmacists or providers for any denials and appeals
• Evaluates patient assistance program opportunities if necessary

45

Refill Authorization 

• Receives and processes refill requests from clinic personnel, a pharmacy or patients
• Using a refill protocol, evaluates refill requests for adherence to the refill protocol criteria; this involves reviewing APeX and contacting a patient
• Notifies pharmacist of specific refill protocol criteria that are not met after assessment
• Notates the need for a provider appointment where applicable
• Discusses recommendations and other pertinent information with the pharmacist
• Conducts a search for any lab test(s) that is needed to fulfill the protocol and analyzes EMR for any needed lab test(s) and notates this need; if needed, inform patients about needed labs
• Pend the order or request for provider appointment based on pharmacist judgment via APeX
• Properly documents each refill request in the patient's chart

10

Administrative Functions

• Assists in training and onboarding new staff and learners regarding the refill and PA processes
• Participates in the pharmacy's continuous quality improvement
• Completes training requirements timely and stay up to date on policies and procedures
• Performs additional tasks as deemed appropriate or necessary by the supervisor/manager pertaining to pharmacy operations and patient care

100%

(To update total %, enter the amount of time in whole numbers (without the % symbol - e.g., 15, 20) then highlight the total sum (e.g., 1%) at the bottom of the column and press F9. The total sum should add up to 100%.)