About the Medication Care Coordination Team
The Medication Care Coordination Team (MCC) is a centralized team that works closely with Specialty Clinics across all Corewell Health regions to help obtain prior authorizations (PA’s) for high-cost medications, quantity limits, tier exceptions, and non-formulary medications that are ordered by providers. The MCC team covers multiple provider offices and specialties and collaborates with insurance companies, pharmacies, and Corewell Health clinics to obtain the necessary information for completing a prior authorization and ensuring accurate prescription processing at the destination pharmacy.
Specialty Pharmacy Scope of Work
Coordinates prior authorization and prescription processing in collaboration with the Corewell Health Specialty Pharmacy (CHSP) staff for specialty medications prescribed for patients of select Corewell Health clinics. Additionally, these liaisons support prior authorization and specialty prescription coordination for specialty medications that are filled at any external specialty pharmacy when prescribed from the covered clinics.
Works in collaboration with clinic and pharmacy staff to facilitate patient access to specialty medications and drive utilization of internal specialty pharmacy services. Performs insurance benefit investigations and prior authorizations to facilitate appropriate access to specialty medications. Coordinates financial assistance through manufacturer and third-party programs to ensure patient affordability. Resolves various adjudication errors and rejections. Communicates directly with prescribing clinic/office staff, patients, and insurance companies to arrange timely approval, fulfillment, and delivery of medications. Provides exceptional customer service through telephone and/or in-person communications. This position may be based within a clinic or in the specialty pharmacy depending upon need.
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Pulls, transcribes, and organizes clinical information from patient charts into third party platforms or navigators.
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Performs all necessary aspects of the medication prior authorization process, including obtaining required medical information, completing paperwork or electronic submission of prior authorization forms, and communicating with third party payers as necessary to obtain approval and prevent therapy interruptions.
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Performs prescription data entry, adjudicates claims, and resolves third party exceptions.
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Identifies patients eligible for financial assistance through manufacturer-provided or third-party sponsored program.
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Facilitates patient enrollment in programs to reduce out-of-pocket expense.
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Documents activities in the appropriate system(s) to provide a record of care and facilitate handoff among various team members.
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Provides exceptional customer service to patients, provider office staff, and all outside business associates.
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Develops collaborative working relationships with providers, clinics, and office-staff.
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Provides education to patients and clinic staff on the benefits and services provided by the Specialty Pharmacy.
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Facilitates patient enrollment in the Specialty Pharmacy Patient Management Program.
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Responsible for data collection and/or reporting related to assigned area/projects as needed.
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Serves as a role model and leader in the department.
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Escalates any concerns that are identified in their area of work through chain of command.
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Participates in training pharmacy team members.
Qualifications
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Required High School Diploma or equivalent
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2 years of relevant experience in Pharmacy Required
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Retail or specialty pharmacy experience Preferred
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LIC-Pharmacy Technician - STATE_MI State of Michigan Upon Hire required And
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CRT-Pharmacy Technician, Certified (CPHT) - PTCB Pharmacy Technician Certification Board 90 Days required Or
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CRT-Exam for the Certification of Pharmacy Technicians (ExCPT) - NHA National Healthcareer Association 90 Days required
Ideal candidate will be a Pharmacy Technician possessing Full Michigan Pharmacy Technician License and National Pharmacy Technician Certification, such as PTCB or ExCPT
Ideal candidate will also possess either Specialty Pharmacy, Prior Authorization experience or Retail Pharmacy experience
This is a position that will require 2-4 Weeks of On-Site Training in Grand Rapids, Michigan, and then will allow this person to work from home, ideally within commuting distance to Grand Rapids, Michigan
Schedule will be Monday to Friday, 8 AM to 5 p.m., No Weekends
How Corewell Health cares for you
Comprehensive benefits package to meet your financial, health, and work/life balance goals.
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On-demand pay program powered by Payactiv
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Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more!
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Optional identity theft protection, home and auto insurance
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Traditional and Roth retirement options with service contribution and match savings
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Eligibility for benefits is determined by employment type and status
Primary Location
SITE - Corewell Health Care Center - 1900 Wealthy St SE - Grand Rapids
Department Name
Employment Type
Full time
Shift
Day (United States of America)
Weekly Scheduled Hours
40
Hours of Work
8 a.m. to 5 p.m.
Days Worked
Monday to Friday
Weekend Frequency
N/A
CURRENT COREWELL HEALTH TEAM MEMBERS – Please apply through Find Jobs from your Workday team member account. This career site is for Non-Corewell Health team members only.
Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and community. We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process, to perform the essential functions of a job, or to enjoy equal benefits and privileges of employment due to a disability, pregnancy, or sincerely held religious belief.
Corewell Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category.
An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization. As a health system, we advocate for equity as we care for our patients, our communities, and each other. From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do. We invite those that share in our commitment to join our team.
You may request assistance in completing the application process by calling 616.486.7447.
