Medication Access Coordinator I
MercyOne, Des Moines, IA, United States
Employment Type
Full time
Description
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.
Essential Functions
Knows, understands, incorporates, and demonstrates the Trinity Health Mission, Vision, and Values in behaviors, practices, and decisions.
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.
Creates contingency workflows for EHR downtime or operational interruptions to ensure essential access tasks continue without delays.
Serves as 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, audits 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, interpreting measure specifications and applying inclusion/exclusion criteria.
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.
Analyzes, prepares, and assigns lists for pharmacist‑managed programs while maintaining operational ownership of targeting and prioritization.
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.
Performs other related duties as assigned by manager and maintains knowledge of applicable laws and regulations.
Minimum Qualifications
High School diploma or GED required.
Post‑secondary education in a health‑related field preferred.
Must be at least 18 years of age.
Iowa Board of Pharmacy‑Certified Pharmacy Technician License required within 6 months of start date.
Alternative medical education/lisence may be considered in combination with applicable experience (e.g., social worker, LPN, etc.).
Minimum 5 years of progressive pharmacy or comparable clinical experience (community, inpatient, ambulatory, insurance, etc.).
1‑2 years of experience documenting in an EHR within ambulatory care, including routing, message pools, smart tools, structured fields, and referral workflows.
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.
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.
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.
Skill in collaborating with data analytics, monitoring, and interpreting 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.
Comfortable operating in a collaborative, shared leadership environment.
Possesses a personal presence characterized by honesty, integrity, and caring, inspiring and motivating others to promote Trinity Health’s mission, vision, goals, and values.
Equal Opportunities Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.
Our Commitment
Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person‑centered care.
#J-18808-Ljbffr
Full time
Description
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.
Essential Functions
Knows, understands, incorporates, and demonstrates the Trinity Health Mission, Vision, and Values in behaviors, practices, and decisions.
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.
Creates contingency workflows for EHR downtime or operational interruptions to ensure essential access tasks continue without delays.
Serves as 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, audits 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, interpreting measure specifications and applying inclusion/exclusion criteria.
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.
Analyzes, prepares, and assigns lists for pharmacist‑managed programs while maintaining operational ownership of targeting and prioritization.
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.
Performs other related duties as assigned by manager and maintains knowledge of applicable laws and regulations.
Minimum Qualifications
High School diploma or GED required.
Post‑secondary education in a health‑related field preferred.
Must be at least 18 years of age.
Iowa Board of Pharmacy‑Certified Pharmacy Technician License required within 6 months of start date.
Alternative medical education/lisence may be considered in combination with applicable experience (e.g., social worker, LPN, etc.).
Minimum 5 years of progressive pharmacy or comparable clinical experience (community, inpatient, ambulatory, insurance, etc.).
1‑2 years of experience documenting in an EHR within ambulatory care, including routing, message pools, smart tools, structured fields, and referral workflows.
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.
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.
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.
Skill in collaborating with data analytics, monitoring, and interpreting 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.
Comfortable operating in a collaborative, shared leadership environment.
Possesses a personal presence characterized by honesty, integrity, and caring, inspiring and motivating others to promote Trinity Health’s mission, vision, goals, and values.
Equal Opportunities Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.
Our Commitment
Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person‑centered care.
#J-18808-Ljbffr