Scope of Position

The Ohio State University Wexner Medical Center is committed to improving access and service to customers. The Department of Pharmacy dedicates resources to a team of specialized Clinical Financial Case Managers who focus on precertification, predetermination, denial management, and medication assistance for infusion medications. This team manages the insurance verification and prior authorization process for outpatient medications and coordinates patient access to medications necessary for their treatment, regardless of their ability to pay. The Manager, Infusion Medication Access acts in a front-line supervisory role for the Clinical Financial Case Manager staff working with predetermination and medication assistance. In this role, the manager maintains functional expertise, participates in appropriate hospital and/or departmental committees; and provides supervision to Clinical Financial Case Managers covering all infusion centers across the health system.

Position Summary

The Manager, Infusion Medication Access provides oversight, hiring, orientation and evaluation of Clinical Financial Case Management staff, identifying and resolving service problems; conducting research in pharmacy practice; assisting with the financial management and budgeting of the department; and participation in the implementation of new technology to improve services, patient care, patient safety, and educational opportunities for staff and students.

This position may be responsible for any of the following: coordinate and implement aspects of the infusion medication access and reimbursement services; develop, implement and monitor programs that guide and support the provision of high quality cost effective pharmaceutical care; maintain appropriate quality and service indicators; ensure compliance with appropriate patient care and business practices; ensure compliance with regulatory and accreditation agencies; adhere to customer service standards and encourage and support service orientation by other staff.

Duties and Responsibilities

Personnel Management (30% effort) This position directly supervises the activities of the Clinical Finance Case

management staff. This position is responsible for using the Performance Excellence (P3) system for staff by developing

SMART goals across job categories, in addition to individual goals that promote staff development, satisfaction, and

engagement. The position oversees recruitment, hiring, onboarding, and retention of all direct reports. In addition, this

person ensures adequate training, competency, and quality review of activities.

Financial Management (30% effort) - This position maintains expertise pertaining to payor polices and rules that

directly relate to authorization and coverage of clinic administered medications. This position assists their team in

providing solutions to patients without insurance or rendered uninsured by an insurance denial for obtaining pharmaceutical products and explore alternative payment options. Additionally, this position maintains current knowledge of federal and commercial insurance structure, authorization requirements and appeal rights and responsibilities and ability to enroll patients in medication assistance programs. This position develops professional working relationships with other hospital and University departments to improve the high-quality care provided to patients and communicates that information to the appropriate personnel, specifically working with directors of revenue cycle to optimize workflow.

Compliance/Quality Improvement (20% effort) This position ensures Clinical Financial Case Management staff are compliant with pharmacy practice laws and guidelines developed by the Board of Pharmacy, DEA, FDA, The Joint Commission, ASHP, GCP, and study-specific guidelines and requirements. This position ensures that competencies are developed and maintained by staff members in the areas applicable to their practice setting and position. In collaboration with others, this position will also participate/initiate quality improvement projects related to pharmacy revenue integrity. This position develops written policies and procedures to streamline Clinical Financial Case Management workflows and enhance efficiency. Additionally develops and implements process and quality improvement activities in coordination with Department of Pharmacy leadership.

Teaching/Training/Educational Activities/Research (10% effort) This position participates in the orientation and

training of volunteers, pharmacy technicians, pharmacists, undergraduate and graduate students, pharmacy residents and

other hospital staff. Showcases commitment to personal growth and development of his/her staff and fosters strong work

ethic with the highest quality workmanship for his/her area. This position serves as a resource for the department on off

label medication use, focusing on reimbursement risks and payment strategies. Provides resources and content

contribution for community connect hospitals and oversees program development and stewardship to outside hospitals in

developing access and reimbursement services within the pharmacy oversight.

Individual professional development (5% effort) This position is required to have an academic emphasis through participating in didactic classroom sessions in pharmacy practice and mentoring all levels of trainees. This position also participates in national committees such as the Alliance of Dedicated Cancer Centers (ADCC), National Comprehensive Cancer Network (NCCN), American Society of Health-System Pharmacists (ASHP) and the Hematology/Oncology Pharmacy Association (HOPA) to create guidelines and best practices medication access and revenue integrity. It is expected that this position publishes papers in peer-reviewed literature, presents scholarly work at regional or national meetings, assists where needed in resident and staff research projects, and participates in local and national professional organizations.

Patient care (5% effort) This position will be expected to provide patient care 1 day /month. Additional time may be required as needed for the successful operation of the pharmacy/department.

Organizational Expectations

Practices within The Ohio State University Wexner Medical Centers policies and procedures. Adheres to organizational values of sincerity, inclusiveness, ownership, determination, innovation, and empathy as demonstrated through positive patient/guest relations, effective interactions with staff and formulating and meeting developmental goals. A high value is placed on dependability, flexibility, productivity, and reliability.

Minimum Qualifications

For Hire: This position must be a licensed pharmacist in good standing with the Ohio Board of Pharmacy. A B.Sc. in Pharmacy, or Doctor of Pharmacy degree (PharmD) is required. An advanced administrative degree (M.S., MHA, MPH, MBA) is preferred. Post-graduate residency training is preferred. In addition, a significant track record in scholarship and teaching are preferred.

Ongoing: Performs professional, supervisory, and teaching functions outlined above. Continues to meet competency and licensure expectations of a staff pharmacist.

Patient Population Served

Knowledge of growth and development and an understanding of the range of treatments necessary to meet the age specific needs of the patient population served (Check those that apply):

Not Applicable: Non-direct patient care title

X

Adolescents (14 - 17 years)

Neonates (0 - 6 months)

Adults (18 - 64 years)

Children (7 months - 13 years)

Geriatrics (65 + years)

Job Relationships

Supervisory Responsibility:

Supervises clinical financial case management staff. Provides information relative to staff performance for use in performance evaluations for staff in the MAP and Pre-D area. Documents and discusses inadequate performance with the above individuals when appropriate (i.e., tardiness, improper techniques, etc.). Manages staff schedules on a daily basis and approves overtime as appropriate.

Contacts: Daily contact with physicians, nurses, pharmacy directors, managers from other health care professions, pharmacists, pharmacy technicians, pharmacy residents, and graduate and undergraduate students. Weekly contact with administrative personnel in the Pharmacy Department.

Responsible to: Associate Director of Pharmacy

Physical/Visual/Mental Requirements

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee must be able to:

• Occasionally move up to 30lb objects (i.e. IV admixtures, stock boxes) from one level to another.
• Occasionally transport up to 30lb objects (i.e. IV admixtures, stock boxes)
• Occasionally push 50lb objects (i.e. biohazard boxes, stock carts, crash carts) so that the object moves toward you.
• Frequently position oneself without moving about (i.e. preparing med bins, preparing IV admixtures)
• Maneuver around area (i.e. preparing medications, placing stock, answering door/window)
• Simultaneously perform multiple functions
• Regularly obtain medications from stock.
• Maneuver in any direction (i.e. obtaining medications from various heights (floor to 8'), obtaining supplies, preparing IV admixture)
• Constantly handle by seizing (i.e separating IV admixtures, grasping syringes, and other supplies, opening medication packages, answering telephones)
• Manipulate objects (i.e. working with unit dose pharmaceuticals, dialing telephone, manipulating syringes and other pharmacy supplies, packaging pharmaceuticals, using a typewriter, computer keyboard)
• Produce clear, intelligible speech 100% of the time (i.e communication with hospital and pharmacy staff)
• Understand verbal communication 100% of the time (i.e. communication with hospital and pharmacy staff)

• Walk and/or push a cart for an extended period of time (i.e. delivery of medication to all nursing units)

Work Environment

The work involves risks or discomforts which require special safety precautions, additional safety education and/or health risk monitoring, e.g. working around moving parts, carts, machines; working with sharps (i.e. needles, syringes, etc.), medications (i.e. chemotherapy, antibiotics, ionizing radiation, etc.), chemicals (i.e. laboratory and/or cleaning agents). Employee may be required to use protective clothing or gear such as masks or gloves.

Note: The above statements are intended to describe the essential functions and related requirements of persons assigned to this job. They are not intended as an exhaustive list of all job duties, responsibilities,

and requirements.