Clinical Pharmacist Specialist, Revenue Cycle - Full-Time Days

UChicago Medicine•Chicago, IL

1d•$158,700 - $185,100•Remote

About The Position

Be a part of a world-class academic healthcare system, University of Chicago Medicine, as a Clinical Pharmacist Specialist for the Infusion Patient Access team. This team is responsible for resolving patient access issues for hospital-administered medication treatment for 25+ ambulatory infusion/provider clinics located in the Chicagoland and Northwest Indiana areas. This fully remote position will be focused on claim denials resolution and drug reimbursement strategy. UChicago will be accepting out-of-state applicants for this role due to the unique experience required; please submit a cover letter outlining your experience with claim denials and outpatient revenue recovery. Outpatient Clinical Pharmacist Specialists provide ambulatory support to deliver optimal medication therapy to both adult and pediatric patients with a broad range of disease states. Clinical Pharmacist Specialists serve as departmental resources and liaisons to other departments, hospital personnel, or external groups. They proficiently manage and facilitate the appropriate use of medications according to professional and regulatory standards. They also conduct clinical research or practice advancement projects as well as patient care quality and regulatory compliance initiatives designed to improve medication-use processes or pharmacy practice. Clinical Pharmacist Specialists provide medication and practice-related education/training. UChicago Medicine sees patients with very rare cancers and autoimmune disease that routinely require appeals and free drug to get treatment covered. The Infusion Patient Access team currently has one Pharmacy Clinical Coordinator, four dedicated Clinical Pharmacist Specialists for autoimmune disease, two dedicated Clinical Pharmacist Specialists for oncology and three Ambulatory Medication Access Coordinators (pharmacy technicians by trade) fully integrated into prior authorization and patient access workflows. Their role is to assist with peer-to-pears, appeals, medical policy review, site of care transfers, pharmacy benefit restrictions, medication assistance, and care coordination to ensure patients have prompt, affordable access to life-saving medication treatment. The team has recently expanded into claim denials review with one dedicated Pharmacy Denials Specialist (pharmacy technician by trade). This specific Clinical Pharmacist Specialist role is to provide support for claim denial appeal letters, data analysis and ownership of denials prevention and revenue improvement strategies. It will be expected that this individual have strong project management skills since the findings for claim denials and underpayments will be brought back to various leaders to implement solutions. There may also be a cross-coverage component for the 2 Clinical Pharmacist Specialists dedicated to oncology for extended vacations.

Requirements

Graduate of an ACPE accredited School of Pharmacy.
Knowledge of contemporary hospital/clinical practice and service.
Knowledge and understanding of general hospital operations and regulatory compliance.
Strong written and verbal communication skills.
Ability to interact constructively with supervisors, peers, and support personnel.
Ability to integrate clinical and distributive pharmacy services with quality improvement, teaching, research, and professional development activities.
Significant expertise in hospital drug reimbursement and claim denials resolution.
Clinical pharmacy experience (2-4 years) in a hospital care setting.
Strong teaching skills and expertise in experiential training.
Eligible for licensure as a pharmacist in the state of Illinois and Indiana (complete licensure process within 60 days of employment). Note: MPJE requirement is now waived for both states.
Doctorate of Pharmacy
Completion of ASHP accredited PGY-1 and/or PGY-2 Pharmacy Residency
Experience with CAR-T and gene therapy reimbursement
Experience at academic medical center with wide range of disease states

Nice To Haves

Doctorate of Pharmacy
Completion of ASHP accredited PGY-1 and/or PGY-2 Pharmacy Residency
Experience with CAR-T and gene therapy reimbursement
Experience at academic medical center with wide range of disease states

Responsibilities

Supports and works closely with the Pharmacy Denials Specialist.
Leads and assists with development and optimization of claim denials program.
Presents denials data findings and resolution steps to pharmacy and precertification team members.
Performs drug reimbursement analyses and presents data to various high-level pharmacy, revenue cycle, finance and managed care leaders.
Performs other duties as assigned and cross-cover oncology when needed.