Welcome to Clearway Health – a recognized Great Place to Work® and destination organization! We are an award-winning culture where talented people are respected, informed, engaged, empowered, developed – and where they want to grow and make a difference. At Clearway Health, diversity, equity, inclusion and belonging is an essential part of our business and workplace culture. We offer a wide range of benefits, perks, and wellness programs in addition to continuous learning opportunities to help you grow. Clearway Health emerged as a solution from Boston Medical Center to improve access to care, provide personal support, and manage the complex specialty medication needs of vulnerable patients and their families. We partner with hospitals, health systems, and the communities they care for to accelerate their specialty pharmacy programs.
The Patient Support Center Liaison position is remote position that through technology and integrated workflows support specialty patients.
ESSENTIAL RESPONSIBILITIES / DUTIES:
Patient Relationship Development, Medication Access Coordination, and Medication Adherence Management – Responsible for managing and retaining patient panels by determining program eligibility for specialty pharmacy services.
1. Benefits Investigation: Leverage understanding of specialty pharmacy eligibility requirements; showing proficiency in benefits investigation process in order to support and maintain ongoing access for patient therapies through various means including: Navigating the patient electronic health record and pharmacy dispensing system
- Contacting patient, caregiver and/or insurance provider directly.
2. Prior Authorization: Comprehensive understanding of the prior authorization process and requirements for securing approval based on unique plan requirements.
- Following submission, this may include reviewing and appealing denied requests by leveraging evidence-based clinical references, drug prescribing information, or the patient health care team support.
3. Copay Assistance: Understand the benefits and dynamics of specialty medications specific to insurance coverage/eligibility, patient financial responsibility to inform patient affordability assessment.
- Investigate specific financial assistance program eligibility criteria based on treatment, plan type, and patient demographic/financial information;
- Evaluate full patient profile to determine eligibility for financial assistance program enrollment;
- Assist patient, patient caregiver and/or health care provider(s) with the financial assistance program application and review process;
4. Ongoing Adherence: Monitor and proactively engage with patients to ensure ongoing access to medication ensuring all questions are answered relating to the medication that may have come up over time.
- As appropriate, connect patient back to care to address ongoing clinical questions or side effects to ensure most appropriate medication continues to be administered to plan.
- Understand and utilize techniques to maintain patient retention for all patients within their oversight. Maintain patient attrition performance at or below established goal.
Personnel Responsibilities – Responsible for building and maintaining relationships with provider, care teams, and ancillary support necessary to sustain patient management activities.
1. Internal Relationships
- Developing and growing trusting relationships with providers and hospital staff to provide highest level of care for a complex patient panel.
- Maintaining and supporting pharmacy interdepartmental relationships and management to ensure seamless transition of patient care from clinic to pharmacy.
2. External Relationships
- Developing and growing trusting relationships with patients to provide highest level of care.
Operational Responsibilities – Technical savvy, and problem solving are required
- Navigate patient Electronic Medical Record (EMR) to effectively answer questions and/or provide documentation as needed for prior authorizations
- Communicate with providers (Doctors, Nurses, Clinical Pharmacists) in person, over the phone, and through written transmission via EMR in a timely and professional manner
- Communicate with Specialty Pharmacy Management, Medical Directors, and Practice Managers to provide support for new and ongoing hospital initiatives
- Resolve some patient care issues with situational awareness around when to involve managers and/ or clinicians
- Demonstrate resourcefulness in the face of challenges and providing workable solutions to complex problems
- Capacity to work independently by managing workload and meeting established goals in a fast paced environment
- Train and support new staff in understanding and learning the expectations for day-to-day operations in a specific role
The above statements in this job description are intended to depict the general nature and level of work assigned to the employee(s) in this job. The above is not intended to represent an exhaustive list of accountable duties and responsibilities required.
- HS Diploma or G.E.D. is required.
- AA or BA is preferred.
CERTIFICATES, LICENSES, REGISTRATIONS REQUIRED:
- Must be currently registered as a Pharmacy Technician or Pharmacy Intern with the Board of Pharmacy in the state of residence of the client.
- Technicians have 6 months from date of hire to become nationally certified through PTCB if not currently registered.
- Must have 4-5 years’ of pharmacy experience.
- Pharmacy Interns – must be in their 2nd year.
KNOWLEDGE AND SKILLS:
- Excellent English oral and written communication skills required; as well as ability to communicate professionally over the phone.
- Excellent interpersonal skills to provide superb personalized customer service and to instill confidence and to advocate for patients; ability to explain required information to customers in a comprehensible manner.
- Other professional skills and qualities: organized, strong attention to detail, ability to self-direct through multitasking and prioritizing, dependable, empathetic, focused on quality service, goal oriented.
- Cultural sensitivity, understanding, and comfort with a wide range of social, racial and ethnic populations.
- Must practice discretion and confidentiality as position deals with highly sensitive and private data.
- Ability to understand, explain, and actively promote the hospital’s objectives through direct coordination and commitment to the program’s goals.
- Flexibility to adapt to changes in the departmental needs including but not limited to: offering assistance to other team members, adjusting assignments, etc.
- Highly proficient in Microsoft Office particularly Excel, Word, and Outlook. Ability to quickly learn other relevant applications that support management of patient care and assigned responsibilities; and ability to extract necessary information.
Additional preferred qualifications:
- Knowledge of transplant, hepatitis C, infectious diseases (including HIV), oncology and/or other specialty medication therapies preferred.
- Bilingual or multi-lingual skills (beyond that of English) appropriate to the patient population served is a plus.
- Experience with submission of prior authorization requests to third party payors.
- Familiarity with 340B drug program.
- Knowledge of QS1/NRx, EPIC, Salesforce, Navinet or other pharmacy and/or EMR systems.