Medication Access Coordinator I

Trinity Health

About The Position

The Medication Access Coordinator II (MAC II) serves as the operational lead for the PHSO Pharmacy business operations team, ensuring that access tasks, quality measures, and workflow standards are executed accurately and efficiently. This role independently manages complex cases, supports workflow accuracy, and collaborates across teams to remove barriers and ensure timely, cost‑effective medication access. The position exists to elevate pharmacy operations and optimize outcomes within value-based care programs. Under the direction of the PHSO Pharmacist Supervisor, the MAC II mentors team members, oversees daily operations, and ensures adherence to policies and workflows. The MAC II also collaborates with leadership to improve processes, serves as a subject matter expert, and can represent the department in internal and external meetings. The role involves providing advanced support to primary care patients and providers, managing complex medication access cases, prioritizing and monitoring pharmacy work, maintaining contingency workflows, and serving as a pharmacy operations specialist for workflow creation, training, and oversight. It also includes ensuring accurate EHR documentation, performing operational audits, establishing documentation expectations, using data for improvements, managing staff orientation and training, aligning activities with quality objectives, and translating HEDIS/Stars requirements into daily work.

Requirements

High School diploma or GED required.
Must be at least 18 years of age.
Iowa Board of Pharmacy Certified Pharmacy Technician License required within 6 months of start date.
Minimum 5 years of progressive pharmacy or comparable clinical experience. (community, inpatient, ambulatory, insurance, etc.)
1-2 years' experience documenting in an EHR within ambulatory care, including routing, message pools, smart tools, structured fields, and referral workflows required.
Experience in medication access operations, including health benefit investigations, prior authorization submission and follow up, denial and appeal strategies, payer specific documentation requirements, and identification of denial patterns required.
Experience contributing to CMS Stars or HEDIS improvement efforts, including familiarity with CMS part D Stars measures.
Working knowledge of value-based contracts, population health performance metrics, and how pharmacy operations support Stars, HEDIS, and other quality programs required.
Experience with patient financial assistance resources, including manufacturer PAPs, foundation grants, co-pay programs, and state or community assistance pathways.
Strong understanding of medical terminology, diagnostic criteria, procedures, and how they influence medication coverage under both pharmacy and medical benefits.
Ability to differentiate between access barriers caused by formulary strategy versus clinical appropriateness, with sound judgment regarding when clinical issues require pharmacist escalation.
Proficient in Excel at an intermediate to advanced level, including pivot tables, filters, conditional logic, and list reconciliation.
Able to collaborate with data analytics, monitor, and interpret dashboards, operational reports, PDC trajectories, cohort performance patterns, and other metrics tied to quality measure outcomes.
Demonstrated ability to identify, troubleshoot, and correct documentation issues that impact operational workflows or quality measure capture.
Proven ability to communicate clearly, and work efficiently and professionally with clinicians, care managers, providers, operational leaders, and patients or caregivers.
Demonstrated ability to manage competing operational priorities, solve multi-factor operational problems, and recognize opportunities for workflow improvement.
Must be comfortable operating in a collaborative, shared leadership environment.
Must possess a personal presence that is characterized by a sense of honesty, integrity, and caring with the ability to inspire and motivate others to promote the philosophy, mission, vision, goals, and values of Trinity Health.

Nice To Haves

Post-secondary education in health-related field.
Alternative medical education/licensure may be considered in combination with applicable experience (i.e., social worker, LPN, etc.).

Responsibilities

Knows, understands, incorporates, and demonstrates the Trinity Health Mission, Vision, and Values in behaviors, practices, and decisions.
Understand confidentiality with respect to patient/client care; complying with all federal and state laws applicable to the confidentiality of protected health information (PHI) and electronic protected health information (EPHI); and follow HIPAA guidelines regarding readily identifiable protected health information.
Provides advanced support to primary care patients and providers by improving medication access and managing complex cases requiring high technical and operational proficiency.
Prioritizes, assigns, and monitors pharmacy list work; directs staff on list management based on quality/performance data and PHSO-defined priorities.
Maintains contingency workflows for EHR downtime or operational interruptions to ensure essential access tasks continue without delays.
Serves as the pharmacy operations specialist responsible for creating, maintaining, training, and overseeing PHSO Pharmacy team workflows.
Ensures accurate EHR documentation, performs operational audits to identify workflow issues, and implements process improvements.
Establishes documentation expectations and turnaround times for MAC I entries, auditing for timeliness and accuracy while monitoring MAC team productivity and program reporting progress.
Uses Excel and EHR reporting to validate lists, track metrics, identify bottlenecks, and recommend improvements that increase compliant gap closure.
Exercises independent judgment in setting operational priorities (lists, queues) and curating payer matrices for alignment.
Manages orientation and training for all pharmacy staff, including interpreting measure specifications and applying inclusion/exclusion criteria to necessary resources.
Aligns pharmacy access activities with quality objectives (e.g., adherence, statin use), coordinating timing and cadence with pharmacists and care management partners.
Translates Stars and HEDIS requirements into daily work by applying CMS Part D and PQA specifications, including numerator/denominator definitions, criteria, and paid-claim closure.
Analyzes, prepares, and assigns lists for pharmacist-managed programs (e.g., chronic disease management such as Diabetes) while maintaining operational ownership of targeting and prioritization; presents monthly operational performance summaries to leadership with progress, barriers, list integrity, and workflow recommendations.
Serves as the operational point of contact across PHSO pharmacy services, medication assistance programs, community partners, and outpatient/specialty teams; standardizes referral criteria and documentation; maintains SOPs/training materials; trains staff in complex access situations; and collaborates with other Care Management programs to identify population health opportunities and define actionable work.
Perform other related duties as assigned by manager.
Maintains a working knowledge of applicable Federal, State, and local laws and regulations, Trinity Health’s Organizational Integrity Program, Standards of Conduct, as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical, and professional behavior.