Mgr,Clinical Administration

University of Rochester•City of Rochester, NY

2d•$70,600 - $105,800•Onsite

About The Position

The Manager of the Neurology Medication Access Program serves as the Administrator of Pharmacy and Therapeutic Access for the Department of Neurology, providing strategic, operational, and administrative leadership for the department’s comprehensive medication access and delivery program. The role oversees access to infusion and specialty therapeutics prescribed within Neurology, supporting a program generating more than $200 million in annual charges and serving more than 6,500 infusions and 20,000 specialty prescriptions annually. The Manager provides strategic leadership and operational oversight for outpatient Neurology therapeutic programs, regional affiliate infusion centers, cell and gene therapy initiatives, home infusion programs, take-home specialty medications, and external patient referrals. As the primary business liaison for medication-related matters, the Manager collaborates with internal teams and external stakeholders, works with the Director of Finance on therapeutic budgets and financial performance, and forecasts growth potential for treatments. The position leads these processes throughout the Neurology department, supervises direct reports including the Pharmacy Access team, and executes departmental and institutional strategic objectives with significant autonomy and independent judgment. The Manager promotes a positive, collaborative work environment and continually works to enhance care quality and the patient experience. The role directs operational management of therapeutic access, including staff and resources, workflows, patient access, authorization and benefits investigation, care coordination, infusion capacity, reporting, and performance improvement. It coordinates with clinicians, pharmacists, institutional leaders, affiliate infusion teams, external pharmacies, payers, and other stakeholders. The Manager plans and oversees relevant capital and operating budgets, financial forecasting and reporting, reimbursement and denial resolution, payer policy and contracting work, medication sourcing, and accurate billing. The position also leads and develops the Pharmacy Access team, including training, scheduling, work review, performance management, and payroll-related duties. It maintains current knowledge of industry standards, payer policies, billing operations, regulatory changes, and quality assurance practices, and shares relevant developments with department and division leaders.

Requirements

Bachelor’s degree and 3 years of relevant experience, or an equivalent combination of education and experience.
Strong project-management skills and the ability to manage multiple programs simultaneously are strongly preferred.
Excellent communication, leadership, and relationship-building skills are strongly preferred.
Proficiency in data analysis and program evaluation is strongly preferred.
Knowledge of insurance policies, access, and approval processes is preferred.
Understanding of the pharmaceutical and therapeutics industry is preferred.
Excellent written and verbal communication skills are preferred.
Ability to think strategically and operationally, critically and systemically is preferred.
Ability to analyze complex problems and formulate evidence-informed plans, solutions, and courses of action is preferred.
Knowledge of process and quality-improvement methodologies and tools is preferred.
Ability to challenge established practices constructively and lead change is preferred.
Ability to analyze, understand, and use operational, clinical, and financial data is preferred.
Ability to establish and maintain cooperative working relationships across all organizational levels is preferred.
Ability to promote and advance diversity, equity, and inclusion is preferred.
Ability to engage and influence team members, including in a matrix reporting structure, is preferred.
Effective mentoring, coaching, and performance-management skills are preferred.
Ability to work independently and meet deadlines is preferred.

Nice To Haves

Master’s degree and 5 years of relevant experience preferred.
Strong project-management skills and the ability to manage multiple programs simultaneously.
Excellent communication, leadership, and relationship-building skills.
Proficiency in data analysis and program evaluation.
Proven experience in budget management and financial reporting.
Knowledge of insurance policies, access, and approval processes.
Understanding of the pharmaceutical and therapeutics industry.
Knowledge of process and quality-improvement methodologies and tools.
Ability to promote and advance diversity, equity, and inclusion.

Responsibilities

Direct and supervise staff and resources to manage daily therapeutic-access operations efficiently.
Analyze operational data and recommend improvements to medication-access procedures and workflows.
Lead Pharmacy Access representatives and coordinate with prior authorization, nursing, clinical, and scheduling teams.
Develop standard processes to improve patient and financial outcomes related to access, utilization, payer policies, authorization, benefits investigation, and care coordination.
Develop operational plans and oversee implementation and maintenance of Neurology therapeutic operating procedures; monitor metrics and evaluate projects for further improvement.
Analyze patient-throughput and site-utilization data to support patient access and infusion capacity.
Communicate improved practices, workflow guidance, feedback, and instruction to clinicians, pharmacists, and external stakeholders.
Coordinate clinical systems, initiatives, space, and resources with institutional leaders and affiliate infusion teams.
Provide billing and operational reports using eRecord and Tableau, address related concerns, and educate division administrators about identified issues.
Facilitate and participate in meetings with department and institutional leadership and resolve policy or insurance coverage problems with relevant leaders.
Develop services based on physician and patient needs and maintain relationships with ordering physicians and other departments.
Plan, manage, and participate in capital and operating budgeting; monitor actual versus budgeted volumes and reforecast as needed.
Oversee financial operations for Neurology infusion, therapeutic, and medication services, including budget preparation, forecasting, and reporting.
Collaborate with billing, prior authorization, Medication Access, and other teams to resolve payer and denial issues, optimize reimbursement, and reduce future risks.
Work with the URMC contracting team on payer policy trends and contracts, and collaborate on single case agreements for high-cost therapies when needed.
Use Power BI, Tableau, and eRecord reporting tools to analyze charges and track manufacturer free-drug replacements and external specialty-pharmacy white-bag use; identify billing errors and compliance risks.
Coordinate medication sourcing with the UR pharmacy supply chain, external specialty pharmacies, and manufacturer programs; address shipment discrepancies and risks to revenue.
Identify and resolve denied authorizations, claims, and underperforming reimbursements, and educate division administrators on related processes.
Ensure ambulatory, take-home, and contractual services are accurately delivered and billed in compliance with revenue-cycle standards and metrics.
Develop business-improvement plans with Neurology division chiefs, administrators, the department chair, and program administrative leadership for newly FDA-approved commercial therapies.
Improve referral processes with UR Home Care, affiliate infusion sites, and external home-infusion agencies and infusion centers; ensure referrals are triaged within the URMC enterprise when possible.
Lead, direct, and evaluate Neurology Pharmacy Access representatives and the services they provide.
Develop educational materials, procedures, resources, training, and guides to support staff learning, patient safety, and financial-risk mitigation.
Plan employee schedules, assign accountabilities, and review work for accuracy.
Meet with the Neurology Infusion team and stakeholders to facilitate information exchange and collaboration.
Set competency-based training expectations and goals, and ensure annual staff mandatory training is completed.
Monitor and edit clerical staff time entry in URHR; approve clerical staff payroll and vacations.
Address performance issues with clerical staff and develop improvement plans with employees.
Build relationships with payers, pharmaceutical manufacturers, external specialty pharmacies, home-infusion companies, patient advocacy groups, and patient-assistance foundations to support timely information entry and appropriate reimbursement.
Oversee processes and strategies that integrate and execute complex initiatives within the department and with external stakeholders.
Maintain current knowledge of standards and best practices related to care, payer policies, billing, insurance issues, and quality assurance for complex, high-cost therapeutics.
Participate in professional development and industry activities, monitor emerging trends and regulatory changes, and share relevant information with department and division leaders.
Perform other duties as assigned.