Ambulatory Medication Access/Referral Coordinator

Saint Francis Hospital•Evanston, IL

23h•$23 - $33

About The Position

The Ambulatory Medication Access and Referral Coordinator provides expert-level support to the Prime Healthcare Ambulatory Services Team across complex ambulatory pharmacy workflows, including referral review and processing, patient scheduling, activity and outcome recordkeeping, and insurance evaluation to support medication access. The coordinator helps implement medication access workflows in newly established ambulatory pharmacy service departments and validates workflows at existing departments. Serving as a liaison among providers, pharmacies, insurance carriers, and patients, the coordinator helps streamline medication access, reduce financial barriers, and support continuity of care. The role independently evaluates referrals for appropriateness, obtains clarification from referring providers, and conducts patient outreach and interviews to gather information and arrange scheduling as needed. It also maintains accurate records in the electronic medical record (EMR). The coordinator brings comprehensive expertise in prior authorization management across insurance types, specialty medication access, and financial assistance coordination. The role supports compliance with 340B program requirements and familiarity with pharmaceutical foundation programs, manufacturer copay assistance cards, and internal medication assistance processes. For cases requiring additional review, the coordinator consults with the Ambulatory Pharmacy Technician Supervisor or overseeing pharmacist to help avoid gaps in care. Using independent judgment, the coordinator prioritizes workflow, manages patient concerns, and helps ensure timely access to medications. Responsibilities include managing insurance authorizations, answering financial questions, documenting authorization outcomes, coordinating assistance and charity options for uninsured or underinsured patients, and serving as a subject matter expert and operational resource to clinical leadership, providers, and prior authorization coordinators.

Requirements

High school diploma or equivalent.
Current State of Illinois pharmacy technician license in good standing.
Certified Pharmacy Technician (CPhT) credential.
Minimum 3 years of experience in ambulatory care, specialty pharmacy, or 340B settings.
Proficiency with electronic medical record (EMR) systems and insurance authorization platforms.
Knowledge of HIPAA regulations and patient confidentiality standards.

Nice To Haves

Working knowledge of pharmaceutical foundation assistance programs and manufacturer copay card enrollment processes.
Experience qualifying and processing patients under 340B drug pricing program guidelines.
Strong understanding of commercial, Medicare, and Medicaid insurance plans and formulary requirements.
Experience coordinating patient outreach and scheduling in a high-volume clinical setting.
Excellent communication skills and ability to collaborate effectively with providers, pharmacies, payers, patients, and external offices.
Strong organizational skills and ability to manage multiple cases and meet deadlines in a fast-paced environment.
Experience with specialty pharmacy.

Responsibilities

Review, process, and independently evaluate patient referrals for ambulatory care services to determine appropriateness.
Collaborate with referring providers to clarify information and conduct patient outreach and interviews to obtain additional information and arrange scheduling as appropriate.
Maintain accurate records of activities and outcomes in the electronic medical record (EMR).
Evaluate patients’ insurance and manage prior authorizations to support timely medication access.
Implement medication access workflows in newly established ambulatory pharmacy departments and validate maintenance of workflows in existing departments.
Serve as a liaison among providers, pharmacies, insurance carriers, and patients to streamline medication access and support continuity of care.
Ensure prescriptions complete the required steps to qualify for the 340B program.
Coordinate financial assistance, including pharmaceutical foundation programs, manufacturer copay assistance cards, internal medication assistance processes, patient assistance enrollment, and available charity options.
Answer financial questions from patients and providers and document authorization outcomes.
Consult with the Ambulatory Pharmacy Technician Supervisor or overseeing pharmacist on cases as appropriate to avoid gaps in care.
Prioritize workflow, manage patient problems, and help ensure patients receive medications in a timely manner.
Serve as a subject matter expert and operational resource to clinical leadership, providers, and prior authorization coordinators.