Description

Responsible for the overall safety and security of the office and its operations; maintains accountability for general supervision of the pharmacy team; provides direct supervision of the processes involved in care of specialty clinic patients; ensures compliance with FDA mandates and self-imposed manufacturer restrictions on particular drugs, as applicable; enforces all federal, state and local laws and regulations pertaining to patient privacy, as well as company policies and procedures.

DUTIES AND RESPONSIBILITIES:
1. Completes quality control and DUR check on specialty prescriptions before written: (1) Drug/Drug interactions; (2) Drug/Disease contraindications; (3) Duplicate therapies; (4) Drug/Formulary requirements; and (5) Drug/Lab contraindications; Provides clinical advice to providers regarding medication treatment plans; Propose maintenance medication dosage adjustments while taking specialty meds; Propose monitoring parameters while taking specialty meds; Resolves prescription discrepancies; and Documents patient interventions with adequate detail in both clinical and non-clinical records as appropriate

2. Obtains insurance authorizations as required; Investigates and manages insurance denials as required; Coordinates between clinical staff, insurance companies, and specialty pharmacies for preparation, clarification, questions, and appeal of prior authorization requests.

3. Provides instructions for taking prescribed specialty medication via in office visit or telephone conversation; Provides instructions for any maintenance medications changes necessary during specialty drug treatment; Creates and provides treatment plan to patient to include appointment and lab requirements to include insurance requirements; Monitors patient compliance to appointments and lab work to ensure prior authorization requirements are met; Monitors adherence to specialty medication; Answers patient, pharmacy, insurance, and outside provider questions while patient is taking specialty medication; Resolves patient, pharmacy, insurance problems while patient is taking specialty medication; and documents patient interventions with adequate detail in both clinical and non-clinical records as appropriate.

4. Manages subordinate employees, including: (1) Pharmacy Technicians and (2) Pharmacy team members; Provides direct supervision of the processes involved contacting pharmacies, insurance companies, and patients;

5. Coordinate Between HOC office and telehealth site offices as needed regarding treatment plans, labs draws, and lab results.

6. Contributes to the development and review of the patient management program; Participates in and delivers patient management program services; Participates in the Quality Management.

7. Responsible for the overall safety and security of the office and its operations; Enforces all federal, state and local laws and regulations pertaining to patient privacy, as well as company policies and procedures.

8. Performs other duties as assigned.