Clinical Financial Case Management Specialist 4

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• Ensure you have all necessary documents available when starting the application process. You can review the additional job description section on postings for documents that may be required.
• Prior to submitting your application, please review and update (if necessary) the information in your candidate profile as it will transfer to your application. Job Title: Clinical Financial Case Management Specialist 4 Department: James | Pharmacy Administration Scope of Position The   Medication Access Lead   position   is responsible   for   providing   efficient and efficacious care to   members   of and   patients served by the   James   Medication Access team . S erving as   a   point of contact   for   the   med ication   access   team   and   clinic al staff ,   including completing   prior authorizations , coordination of all medication access   needs ,   and   effectively   communicating with in   the   medication access   teams, clinic   team   and patient . This position   requires clinical   understanding   and   a n   expert   level   of   payor requirement   knowledge,   and   the ability to use and work   with high   profici ency   in the Integrated Health Information Systems (IHIS) .    In addition, this position provides communication   and collaboration   with   other departments such as   Financial Counseling,   MIM, PCRMs,   p hysicians   and other providers .   The individual   must   act as a subject matter expert for the medication access team, recognizing trends and recommending process improvements to enhance workflow efficiency, while fostering collaboration and coordination with prior authorization and medication   assistance   teams to ensure patients have access to the medications they need. Position

Summary

Th is position   is responsible for   all   work related to   Clinical Finance Case Managers I-III   and escalation of issues to the   appropriate teams   to ensure   tim ely   resolution . The   Medication Access

• Lead   requires   a   strong understanding of disease implications, use of various treatment modalities, expected outcomes ,   insurance eligibility,   and   clinic specific workflows , in addition   to   demonstrating   exceptional communication ,   interpersonal , and organizational   skillsets. The   Medication Access
• Lead   responsibilities include   advanced knowledge and understanding of payor specific requirements   and benefit   verification , obtaining prior authorization (s) , and collecting and interpreting patient clinical information. In addition, the   Medication Access
• Lead   ensures comprehensive care of   patient’s   medication needs through   accurate   and   timely   authorization process es and   when needed,   contact ing   patients to gather   pertinent   information   as needed .
• Excellent c ommunication , verbal and written ,   with physicians,   nurses,   payers,   supporting staff,   and other customer groups   is required to   ensure   accurate   and   visible   resolution s   across teams .   Medication Access
• Lead s must be able to navigate   IHIS   to obtain and interpret pertinent medical information for the prior authorization process, including the determination of whether a medication is being used within or outside FDA labeling, relevant lab results   and any other pertinent information needed.

Minimum Qualifications

Bachelor's degree or equivalent experience. Advanced degree in relevant field may be desirable. 6 years of relevant experience required.

8-12 years of relevant experience preferred. Additional Information: Location: James Outpatient Care (1043) Position Type: Regular Scheduled Hours: 40 Shift: First Shift Final candidates are subject to successful completion of a background check. A drug screen or physical may be required during the post offer process.

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