Medication Management Navigator - Sutter Health
Berkeley, CA
About the Job
Organization:
ABSMC-Alta Bates Herrick Campus
Position Overview:
Performs pharmaceutical procedures for medication preparation and distribution that ensures safe, effective, and cost efficient medication therapy. Exercises sound judgment, and developed clinical skills to provide pharmaceutical support to the patient's plan of care based on the diagnosis in a timely manner. Adheres to all local/state/federal regulations, codes, policies and procedures to ensure privacy and safety. May also be responsible for performing specific procedures and/or orienting other staff to the department.
Job Description :
_These Principal Accountabilities, Requirements and Qualifications are not exhaustive, but are merely the most descriptive of the current job. Management reserves the right to revise the job description or require that other tasks be performed when the circumstances of the job change (for example, emergencies, staff changes, workload, or technical development)._
JOB ACCOUNTABILITIES:
PATIENT ADVOCATE SERVICES:
• Verifies all insurance and eligibility information is accurate and update insurance record if necessary.
• Responsible for obtaining initial and subsequent Preferred provider organization (PPO) authorizations.
• Initiates referrals to managed care for Health maintenance organization (HMO) authorizations.
• Follows-up to ensure medications delivered to patient in a timely manner.
• Reviews schedules a minimum of 5 days prior to ensure all treatments are authorized.
• Associates authorization with patient’s appointment in scheduling system.
• Accurately enters all authorization requests into the EPIC system utilizing appropriate codes, treatment types and providers.
• Enters supporting data into comment box. Communicates with supervisor or charge nurse, physicians, practice staff when there are issues with authorization.
• May verify neurology and various chronic inflammatory diseases (CID) treatments, chemotherapy and/or non-chemotherapy are Food and Drug Administration (FDA) or compendia approved for given diagnosis as well as meets insurance specific guidelines.
• May perform clinical trial insurance verification and authorization.
• Obtains medical and pharmacy prior authorization.
• May submit authorization with prescription to insurance-specific mail-order specialty pharmacies when appropriate.
• Reviews Electronic Medical Record (EMR) daily or within 48-hours to verify for accuracy of International Classification of Diseases (ICD-9), Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS) codes and edits as needed. If coding errors and trends are found, is responsible for educating nurses/MDs on correct use of the codes per government payor guidelines. Sends to data processing for posting.
• Follows up in EMR to ensure charges have been posted.
• Provides financial counseling for patients prior to start/during treatment regarding insurance benefits and out of pocket expenses.
• Provides estimate cost of treatment when requested by patient or staff. If an ordered treatment is considered off label per guidelines, the position is responsible for creating and explaining financial/ABN waivers to patients prior to receiving treatment.
• Assists patients who cannot afford meds, treatment or co-pays to access patient assistance programs.
CONTINUOUS IMPROVEMENT:
• Follows the commitment to excellence and treats patients, families, visitors and each other with courtesy, dignity, respect and professionalism.
RELATIONSHIP MANAGEMENT:
• Assists physicians and patients with appeals process when treatment is denied.
• Meets with pharmaceutical drug reps regarding supported patient assistance programs and refers patients to Social Worker for other assistance programs and community services.
• Develops relationships with staff within and outside of the department to facilitate the authorization process and resolution of billing issues.
• Communicates positively and effectively with physicians, staff and patients.
• Works closely with Revenue Cycle to resolve billing issues.
PHARMACY SERVICES.
•Assists in the provision of pharmaceutical services including drug preparation, distribution, inventory control, quality control, and proper documentation according to policy and procedure.
•Performs billing, pricing, record keeping and provision of services required to meet regulatory requirements.
•Maintains records of drug distribution, works with vendors to requisition or return drugs.
•Accurately interprets, transcribes and dispenses orders/prescriptions, under the direction of a Pharmacist.
•Ensures that routine and priority tasks are completed within established departmental time frames.
•Mentors and fosters a constructive teaching environment that helps students, interns, and Pharmacy Technicians build confidence in their skills, knowledge and abilities.
CLERICAL.
•Performs general clerical tasks, such as answering phones; updating patient information; or retrieving, entering, and revising patient Electronic Health Records (EHR).
•Prepares and completes accurate documentation related to patient in medical and departmental records as required.
SAFETY.
•Participates in quality improvement processes, including updating and revision of safety and procedure manuals and interdisciplinary projects.
•Maintains a clean, neat, and safe working environment by complying with policies, procedures and regulations.
•Protects patients and technicians by adhering to infection-control protocols.
COMPLIANCE.
•Maintains strictest confidence of all patient Protected Health Information (PHI) and protects all PHI from accidental, intentional, or inappropriate disclosure.
•Assists the Pharmacists in preparing, administering, and documenting medications and treatments in accordance with state and federal regulations.
•Complies with state and federal drug laws as regulated by the state board of pharmacy, the drug enforcement administration, and the food and drug administration by assisting Pharmacists in monitoring nursing unit inspections; maintaining records for controlled substances; removing outdated and damaged drugs from the pharmacy inventory; maintaining current registration; studying existing and new legislation; anticipating legislation.
•Retains certification and completes mandated continuing education requirements to meet facility and regulatory agencies accreditation and licensure requirements.
EDUCATION:
Other: Graduate of an accredited Pharmacy Technician program
CERTIFICATION & LICENSURE:
PHRMTECHR-Registered Pharmacy Technician
OR PHARMT-Pharmacy Technician
OR PHARMC-Certified Pharmacy Technician
TYPICAL EXPERIENCE:
1 year recent relevant experience
SKILLS AND KNOWLEDGE:
Knowledge of medical terminology, generic and trade pharmaceutical names, pharmaceutical calculations and laws and regulations.
Knowledge and understanding of different Pharmacy practice settings, including narcotic delivery and procedures.
Knowledge and ability to identify and employ pharmaceutical and medical terms, abbreviations and symbols commonly used in prescribing, dispensing, and record keeping of medications.
Requires a basic working knowledge of legal requirements and accreditation standards including The Joint Commission, Title XXII, Department of Homeland Security (DHS), Drug Enforcement Administration (DEA), Food and Drug Administration (FDA), and United States Pharmacopeia (USP).
Possess written and verbal communications skills to explain sensitive information clearly and professionally to diverse audiences, including non-medical people.
Well-developed time management and organizational skills, including the ability to prioritize assignments and work within standardized operating procedures and scientific methods to achieve objectives and meet deadlines
General knowledge of computer applications, such as Microsoft Office Suite (Word, Excel and Outlook), related pharmaceutical technology, EHR, and EPIC.
PHYSICAL ACTIVITIES AND REQUIREMENTS:
See required physical demands, mental components, visual activities & working conditions at the following link: Job Requirements (https://sutterhealth.sharepoint.com/:b:/s/JobAnalysisLibrary/Ea3uFqI6NipIok564Jy7RYwBKjpRGQ1u_zCz81Y0eOEjhg?e=B5YKPg)
Job Shift:
Days
Schedule:
Full Time
Shift Hours:
8
Days of the Week:
Friday, Monday, Thursday, Tuesday, Wednesday
Weekend Requirements:
None
Benefits:
Yes
Unions:
No
Position Status:
Non-Exempt
Weekly Hours:
40
Employee Status:
Regular
Number of Openings:
1
Sutter Health is an equal opportunity employer EOE/M/F/Disability/Veterans.
Pay Range is $36.02 to $45.02 / hour
_The salary range for this role may vary above or below the posted range as determined by location. This range has not been adjusted for any specific geographic differential applicable by area where the position may be filled. Compensation takes into account several factors including but not limited to a candidate’s experience, education, skills, licensure and certifications, department equity, training and organizational needs. Base pay is just one piece of the total rewards program offered by Sutter Health. Eligible roles also qualify for a comprehensive benefits package._
All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, marital status, sexual orientation, registered domestic partner status, sex, gender, gender identity or expression, ancestry, national origin (including possession of a driver's license issued to individuals who did not present proof of authorized presence in the U.S.), age, medical condition, physical or mental disability, military or protected veteran status, political affiliation, pregnancy or perceived pregnancy, childbirth, breastfeeding or related medical condition, genetic information or any other characteristic made unlawful by local, state, or federal law, ordinance or regulation. External hires must pass a background check/drug screening. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state, and local laws, including but not limited to the San Francisco Fair Chance Ordinance.
ABSMC-Alta Bates Herrick Campus
Position Overview:
Performs pharmaceutical procedures for medication preparation and distribution that ensures safe, effective, and cost efficient medication therapy. Exercises sound judgment, and developed clinical skills to provide pharmaceutical support to the patient's plan of care based on the diagnosis in a timely manner. Adheres to all local/state/federal regulations, codes, policies and procedures to ensure privacy and safety. May also be responsible for performing specific procedures and/or orienting other staff to the department.
Job Description :
_These Principal Accountabilities, Requirements and Qualifications are not exhaustive, but are merely the most descriptive of the current job. Management reserves the right to revise the job description or require that other tasks be performed when the circumstances of the job change (for example, emergencies, staff changes, workload, or technical development)._
JOB ACCOUNTABILITIES:
PATIENT ADVOCATE SERVICES:
• Verifies all insurance and eligibility information is accurate and update insurance record if necessary.
• Responsible for obtaining initial and subsequent Preferred provider organization (PPO) authorizations.
• Initiates referrals to managed care for Health maintenance organization (HMO) authorizations.
• Follows-up to ensure medications delivered to patient in a timely manner.
• Reviews schedules a minimum of 5 days prior to ensure all treatments are authorized.
• Associates authorization with patient’s appointment in scheduling system.
• Accurately enters all authorization requests into the EPIC system utilizing appropriate codes, treatment types and providers.
• Enters supporting data into comment box. Communicates with supervisor or charge nurse, physicians, practice staff when there are issues with authorization.
• May verify neurology and various chronic inflammatory diseases (CID) treatments, chemotherapy and/or non-chemotherapy are Food and Drug Administration (FDA) or compendia approved for given diagnosis as well as meets insurance specific guidelines.
• May perform clinical trial insurance verification and authorization.
• Obtains medical and pharmacy prior authorization.
• May submit authorization with prescription to insurance-specific mail-order specialty pharmacies when appropriate.
• Reviews Electronic Medical Record (EMR) daily or within 48-hours to verify for accuracy of International Classification of Diseases (ICD-9), Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS) codes and edits as needed. If coding errors and trends are found, is responsible for educating nurses/MDs on correct use of the codes per government payor guidelines. Sends to data processing for posting.
• Follows up in EMR to ensure charges have been posted.
• Provides financial counseling for patients prior to start/during treatment regarding insurance benefits and out of pocket expenses.
• Provides estimate cost of treatment when requested by patient or staff. If an ordered treatment is considered off label per guidelines, the position is responsible for creating and explaining financial/ABN waivers to patients prior to receiving treatment.
• Assists patients who cannot afford meds, treatment or co-pays to access patient assistance programs.
CONTINUOUS IMPROVEMENT:
• Follows the commitment to excellence and treats patients, families, visitors and each other with courtesy, dignity, respect and professionalism.
RELATIONSHIP MANAGEMENT:
• Assists physicians and patients with appeals process when treatment is denied.
• Meets with pharmaceutical drug reps regarding supported patient assistance programs and refers patients to Social Worker for other assistance programs and community services.
• Develops relationships with staff within and outside of the department to facilitate the authorization process and resolution of billing issues.
• Communicates positively and effectively with physicians, staff and patients.
• Works closely with Revenue Cycle to resolve billing issues.
PHARMACY SERVICES.
•Assists in the provision of pharmaceutical services including drug preparation, distribution, inventory control, quality control, and proper documentation according to policy and procedure.
•Performs billing, pricing, record keeping and provision of services required to meet regulatory requirements.
•Maintains records of drug distribution, works with vendors to requisition or return drugs.
•Accurately interprets, transcribes and dispenses orders/prescriptions, under the direction of a Pharmacist.
•Ensures that routine and priority tasks are completed within established departmental time frames.
•Mentors and fosters a constructive teaching environment that helps students, interns, and Pharmacy Technicians build confidence in their skills, knowledge and abilities.
CLERICAL.
•Performs general clerical tasks, such as answering phones; updating patient information; or retrieving, entering, and revising patient Electronic Health Records (EHR).
•Prepares and completes accurate documentation related to patient in medical and departmental records as required.
SAFETY.
•Participates in quality improvement processes, including updating and revision of safety and procedure manuals and interdisciplinary projects.
•Maintains a clean, neat, and safe working environment by complying with policies, procedures and regulations.
•Protects patients and technicians by adhering to infection-control protocols.
COMPLIANCE.
•Maintains strictest confidence of all patient Protected Health Information (PHI) and protects all PHI from accidental, intentional, or inappropriate disclosure.
•Assists the Pharmacists in preparing, administering, and documenting medications and treatments in accordance with state and federal regulations.
•Complies with state and federal drug laws as regulated by the state board of pharmacy, the drug enforcement administration, and the food and drug administration by assisting Pharmacists in monitoring nursing unit inspections; maintaining records for controlled substances; removing outdated and damaged drugs from the pharmacy inventory; maintaining current registration; studying existing and new legislation; anticipating legislation.
•Retains certification and completes mandated continuing education requirements to meet facility and regulatory agencies accreditation and licensure requirements.
EDUCATION:
Other: Graduate of an accredited Pharmacy Technician program
CERTIFICATION & LICENSURE:
PHRMTECHR-Registered Pharmacy Technician
OR PHARMT-Pharmacy Technician
OR PHARMC-Certified Pharmacy Technician
TYPICAL EXPERIENCE:
1 year recent relevant experience
SKILLS AND KNOWLEDGE:
Knowledge of medical terminology, generic and trade pharmaceutical names, pharmaceutical calculations and laws and regulations.
Knowledge and understanding of different Pharmacy practice settings, including narcotic delivery and procedures.
Knowledge and ability to identify and employ pharmaceutical and medical terms, abbreviations and symbols commonly used in prescribing, dispensing, and record keeping of medications.
Requires a basic working knowledge of legal requirements and accreditation standards including The Joint Commission, Title XXII, Department of Homeland Security (DHS), Drug Enforcement Administration (DEA), Food and Drug Administration (FDA), and United States Pharmacopeia (USP).
Possess written and verbal communications skills to explain sensitive information clearly and professionally to diverse audiences, including non-medical people.
Well-developed time management and organizational skills, including the ability to prioritize assignments and work within standardized operating procedures and scientific methods to achieve objectives and meet deadlines
General knowledge of computer applications, such as Microsoft Office Suite (Word, Excel and Outlook), related pharmaceutical technology, EHR, and EPIC.
PHYSICAL ACTIVITIES AND REQUIREMENTS:
See required physical demands, mental components, visual activities & working conditions at the following link: Job Requirements (https://sutterhealth.sharepoint.com/:b:/s/JobAnalysisLibrary/Ea3uFqI6NipIok564Jy7RYwBKjpRGQ1u_zCz81Y0eOEjhg?e=B5YKPg)
Job Shift:
Days
Schedule:
Full Time
Shift Hours:
8
Days of the Week:
Friday, Monday, Thursday, Tuesday, Wednesday
Weekend Requirements:
None
Benefits:
Yes
Unions:
No
Position Status:
Non-Exempt
Weekly Hours:
40
Employee Status:
Regular
Number of Openings:
1
Sutter Health is an equal opportunity employer EOE/M/F/Disability/Veterans.
Pay Range is $36.02 to $45.02 / hour
_The salary range for this role may vary above or below the posted range as determined by location. This range has not been adjusted for any specific geographic differential applicable by area where the position may be filled. Compensation takes into account several factors including but not limited to a candidate’s experience, education, skills, licensure and certifications, department equity, training and organizational needs. Base pay is just one piece of the total rewards program offered by Sutter Health. Eligible roles also qualify for a comprehensive benefits package._
All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, marital status, sexual orientation, registered domestic partner status, sex, gender, gender identity or expression, ancestry, national origin (including possession of a driver's license issued to individuals who did not present proof of authorized presence in the U.S.), age, medical condition, physical or mental disability, military or protected veteran status, political affiliation, pregnancy or perceived pregnancy, childbirth, breastfeeding or related medical condition, genetic information or any other characteristic made unlawful by local, state, or federal law, ordinance or regulation. External hires must pass a background check/drug screening. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state, and local laws, including but not limited to the San Francisco Fair Chance Ordinance.
Source : Sutter Health