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Clinical Support Nurse Practitioner

Company: Paragon Healthcare
Location: Plano
Posted on: May 14, 2022

Job Description:

Position Summary:The Patient Access Clinician is responsible for carrying out the daily duties and responsibilities for the provision of specialty infusion clinical reviews. The pharmacist is responsible for managing the clinical activities, operational priorities, and enterprise site of care management of the specialty infusions.Education/Experience:Doctorate Degree in Pharmacy and a current state pharmacy license are required or Current Nurse Practitioner license in good standing with all governing bodies. Continuing education necessary to maintain current licensure in all states licensed.Strong clinical knowledge of pharmaceuticals and disease states to conduct prior authorization reviewsStrong clinical writing and verbal skillsDemonstrated critical thinking and problem-solving skills.Knowledge of specialty pharmaceuticals and billing practices in the medical and pharmacy benefitsResponsible to:VP of Patient AccessHealth Status Requirements:Ability to lift 50 poundsAppropriate immunizations currentTB screen (as required by policy)Hepatitis B vaccine or signed waiverOther state required health tests allowable by lawJOB DESCRIPTION KEY INDICATORSMAJOR RESPONSIBILITIESMaintains expert knowledge in market and service dynamics surrounding specialty pharmaceuticals including patient out-of-pockets, 3rd party program utilization, pharmacy & medical benefit structures, pharmaceutical pricing, and other relevant considerations that support the provision of specialty pharmacy care.Collaborates with the Patient Access interdisciplinary clinical team on new specialty infusion clinical reviews, site of care management, and ongoing payer analysis of Specialty Infusion therapies.Serves as subject matter expert in Specialty Infusions across multiple sites of care. Research drug information to maintain drug knowledge and disease state understanding for application to prior authorization reviewsDesigns and executes training initiatives across pharmacy departments that support the success of specialty infusion programs in various sites of care.Conducts initial and ongoing assessments of specific patient, drug and disease information to identify real and potential drug related issues which includes payer criteria clinical review for prior authorizations and appeals.Leads clinical projects to ensure authorization/billing compliance and revenue capture optimization.Performs clinical chart reviews for specialty infusion prior authorization and other specialty pharmacist duties assignedMaintains up to date on payer criteria for Specialty Infusions including NDC/HCPC/JCode changes, template revisions, supply & ancillary needs, etc.WORK STANDARDSUnderstands and adheres to all external accreditation review standards, applicable state, local and Federal laws and / or regulations including maintaining patient confidentiality through abiding by HIPAA laws/regulations.Understands and adheres to all company policies and procedures.Ability to work under strict guidelines, competing priorities, and immediate requests.Establishes and maintains positive working relationships with internal and external customers as well as all company employees.Displays a neat, clean, and professional appearance at all times.Handles customer/patient complaints in a fair and empathetic manner.Promotes PHI culture by providing quality, comprehensive services to all customers through a team approach.CONTINUING EDUCATIONCompletes continuing education necessary to maintain current licensure in all states licensed.Completes continuing education and training as assigned by supervisorObtain Certified Specialty Pharmacist certification within 2 years of employmentTECHNICALCompetent with office computer program (i.e. CPR+).Competent at partner programs (i.e. Word, Excel, PowerPoint).Effective written and oral communication skills.IND123L

Keywords: Paragon Healthcare, Plano , Clinical Support Nurse Practitioner, Healthcare , Plano, Texas

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