Ambulatory Medication Access/Referral Coordinator

St. Mary's Hospital - Kankakee•Kankakee, IL

2d•$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 for newly established ambulatory pharmacy service departments and validates workflows at existing departments. The role serves as a liaison among providers, pharmacies, insurance carriers, and patients to streamline access to medications, reduce financial barriers, and support continuity of care. The coordinator independently manages and evaluates patient referrals to determine whether they are appropriate, collaborates with referring providers to clarify information, and conducts patient outreach and interviews to obtain additional information and arrange scheduling as appropriate. The role maintains accurate electronic medical record documentation of activities and brings comprehensive expertise in prior authorization management, insurance types, specialty medication access, and financial assistance in ambulatory care settings. It also applies knowledge of 340B program requirements and ensures prescriptions complete the steps needed to qualify. The coordinator understands pharmaceutical foundation programs, manufacturer copay assistance cards, and internal medication assistance processes. Depending on the acuity of medication access issues or referrals, the coordinator reviews cases with the Ambulatory Pharmacy Technician Supervisor or overseeing pharmacist as appropriate. Using independent judgment, the coordinator prioritizes workflow, manages patient problems, helps ensure timely medication access, handles insurance authorization, answers financial questions, and documents authorization outcomes. The position also manages referrals for uninsured and underinsured patients to support enrollment in patient assistance and available charity options, and serves 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.
At least 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 the ability to collaborate effectively with providers, pharmacies, payers, patients, and external offices.
Strong organizational skills, including the ability to manage multiple cases and meet deadlines in a fast-paced environment.

Responsibilities

Review and process ambulatory care referrals and independently assess whether referrals are appropriate.
Collaborate with referring providers to clarify referral information.
Conduct patient outreach and interviews to gather additional information and schedule appointments as appropriate.
Maintain accurate electronic medical record documentation of activities and outcomes to support coordination of care.
Evaluate patient insurance and manage prior authorizations, including specialty medication access and insurance authorization workflows.
Implement medication access workflows for newly established ambulatory pharmacy service departments and validate workflows at existing departments.
Ensure prescriptions complete required steps to qualify for the 340B program.
Coordinate financial assistance, including pharmaceutical foundation programs, manufacturer copay assistance, and internal medication assistance processes.
Review higher-acuity medication access cases or referrals with the Ambulatory Pharmacy Technician Supervisor or overseeing pharmacist as appropriate.
Prioritize workflow and manage patient problems using independent judgment to help ensure timely medication access.
Answer financial questions from patients and providers and document authorization outcomes.
Manage uninsured and underinsured patient referrals to support enrollment in patient assistance and available charity options.
Serve as a liaison among providers, pharmacies, insurance carriers, and patients.
Serve as a subject matter expert and operational resource to clinical leadership, providers, and prior authorization coordinators.