As a community, the University of Rochester is defined by a deep commitment to Meliora - Ever Better. Embedded in that ideal are the values we share: equity, leadership, integrity, openness, respect, and accountability. Together, we will set the highest standards for how we treat each other to ensure our community is welcoming to all and is a place where all can thrive.
Job Location (Full Address):
601 Elmwood Ave, Rochester, New York, United States of America, 14642
Opening:
Worker Subtype:
Regular
Time Type:
Full time
Scheduled Weekly Hours:
40
Department:
400045 Neurology - MC Admin M&D
Work Shift:
UR - Day (United States of America)
Range:
UR URG 113
Compensation Range:
$77,600.00 - $116,400.00 The referenced pay range represents the minimum and maximum compensation for this job. Individual annual salaries/hourly rates will be set within the job's compensation range, and will be determined by considering factors including, but not limited to, market data, education, experience, qualifications, expertise of the individual, and internal equity considerations.
Responsibilities:
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 Manager oversees access to infusion and specialty therapeutics prescribed within Neurology department, supporting a program that generates more than $200 million in annual charges and serves more than 6,500 infusions and 20,000 specialty prescriptions annually. Additionally, the Manager provides strategic leadership and operational oversight for a wide range of services, including outpatient Neurology therapeutic programs, regional affiliate infusion centers, cell and gene therapy initiatives, home infusion programs, take-home specialty medications and the management of external patient referrals within the department. Operates as the primary business liaison on all medication related matters with both internal teams and external stakeholders. Collaborates with the Director of Finance to develop therapeutics budgets and monitor financial performance. Additionally, forecasts growth potential for new and existing treatments used within Neurology program, ensuring strategic alignment with organizational objectives. Provides leadership, direction and oversight for these processes for the entirety of the Neurology department. Responsible for supervising direct reports including Pharmacy Access team. Executes strategic objectives set by the department and institutional leadership with a high level of autonomy and independent judgment. Promotes a positive and collaborative work environment by modeling the I CARE values, continually striving to enhance the quality of care and patient experience in every aspect of his/ her responsibilities.
ESSENTIAL FUNCTIONS
Operational Management
- Direct and supervise staff and resources to ensure efficient management of daily operations for therapeutic access. Collects data from various sources to analyze, interpret, and to make recommendations for improving procedures and workflows related to all medication and therapeutics access.
- Acts as an accountable leader for the pharmacy access representatives as well as the liaison between the prior authorization, nursing, clinical and scheduling team members.
- Identifies and creates standard processes that drive measurable progress toward achieving desired patient and financial outcomes by advancing access, utilization, payer policy contracts, authorization, benefits investigation and care coordination.
- Develop operational plans and directs enterprise-wide activities associated with implementation and maintenance of Neurology operating procedures as it relates to therapeutics to mitigate issues and monitors performance metrics for opportunities for improvement. Re-evaluates implementation of projects to assess and determine further recommendations to improve care and efficiencies.
- Collects, analyzes and interprets data to ensure optimal patient throughput and maximum patient access. Monitors multiple infusion site’s utilization to ensure that the program is performing at maximum capacity.
- Identifies and effectively communicates existing and newly improved practices, concepts, workflow guidance, constructive feedback and instruction to over 100 clinicians and pharmacists to support continuous improvement and proactive problem-solving. Provides strategic input to a wide-range of external stakeholders, including the 30+ home infusion and specialty and limited-distribution pharmacies frequently utilized by the Neurology practice. Collaborates with key institutional leaders to integrate clinical systems and initiatives with affiliate infusion teams to coordinate space/ resource availability when necessary.
- Provides billing and operational reports using eRecord and Tableau to medication team and addresses all related concerns. Provides education and feedback to division administrators related to any identified issues.
- Facilitates and participates in meetings with key department and institutional leadership across URMC and affiliate systems as scheduled/required. Problem-solves with institutional leaders including pharmacy, hospital administration, contracting teams and hospital finance when faced with policy changes or insurance coverage issues.
- Develops and implements services based on physician and patient needs, promoting department growth. Maintains strong relationships with ordering physicians and other departments to ensure optimal patient care.
Financial Management
- Plans, manages and participates in relevant department capital and operating budgeting processes. Maintains an ongoing awareness in unison with the department finance director on budget planning and development as it relates to infusion volume and pharmaceutical use projections. Monitors actual vs. budgeted volumes throughout the fiscal year and reforecasts as necessary to keep hospital finance department abreast of new therapeutic agents coming to market and projects usage across the department including incremental revenue projections.
- Oversees financial operations for Neurology infusion, therapeutic, and medication services, including budget preparation, financial forecasting and financial reporting in collaboration with the Program Administrator.
- Collaborates with various hospital departments, including PFS/Billing, Prior Authorization, and the Medication Access team, to resolve payer and denial issues. Works to optimize reimbursements while developing protocols to minimize future risks and ensure smoother financial processes within the department.
- Establishes and maintains proactive communication with URMC contracting team to identify payer policy trends, provide detailed insights for updating policies and contracts, and ensure that the use of UR pharmacy services over external pharmacies. Additionally, collaborates with contracting director to secure single case agreements, when necessary, for specific high-cost, multi-million-dollar gene and cell-based therapies).
- Utilizes Power BI, tableau and e-Record reporting tools to analyze charges and track the utilization of free drug replacements from manufacturers, as well as external specialty pharmacy white bag usage. Monitors these processes to identify and prevent billing errors or potential compliance issues, ensuring accurate and compliant financial operations.
- Leads collaboration with the UR pharmacy supply chain to closely monitor the sourcing of medications, including external specialist pharmacies and manufacturer free drug programs. Ensures that timely and accurate receipt of shipments, promptly identifies and resolves discrepancies, and proactively addresses issues to mitigate any risks to revenue.
- Facilitates the early identification and effective resolution of denied authorizations, claims or reimbursements below expectations. Additionally, provides education and guidance to division administrators across the department to improve process and understanding for all.
- Works collaboratively to ensure all ambulatory, take-home and contractual services are accurately delivered and billed correctly, in compliance with institutional revenue cycle standards and metrics.
- Develop business improvement plans by collaborating with division chiefs, administrators, department chair and program administrative leadership within the Neurology department for successful integration of for newly FDA commercially approved therapies.
- Collaborates with UR Home Care, affiliate infusion sites and over 30+ external home infusion agencies and external infusion centers to continually enhance and streamline the referral process, improving access and care for Neurology patients who receive infusions at an off-site/ home infusion location. Enforce workflows to ensure that all referrals are triaged within the URMC enterprise when possible.
Staff Supervision/Orientation
- Leads and oversees a team of Neurology pharmacy access representatives driving efficient multi-faceted operations and ensuring the delivery of high-quality, comprehensive services across all areas.
- Develops and provides educational material, procedural resources, training and guides to staff to enhance learning, mitigate financial risks, and ensure patient safety. Leads, directs, and evaluates the work of a team that operates with considerable autonomy and independence in their responsibilities.
- Develops and plans employee schedules to meet operational needs. Assigns accountabilities and reviews completed work for accuracy.
- Meets regularly with the Neurology Infusion team as well as key representatives and stakeholders to facilitates information exchange and foster a collaborative work environment.
- Ensures training and comprehension is competency based, providing clear expectations and well-defined goals to trainees for successful development and career-path satisfaction.
- Ensures annual staff mandatories are completed.
- Monitors and edits clerical staff time entry in URHR, approves clerical staff payroll and vacations.
- Counsels clerical staff regarding performance issues and develops with the staff, plans to improve.
Communications
- Establishes and cultivates strong, collaborative relationships with key external stakeholders, including third party payer representatives, pharmaceutical manufacturers, external specialty pharmacies, home infusion companies, patient advocacy groups and patient assistance foundations to ensure appropriate and timely entry of information into hospital systems, securing to correct and full reimbursement. Brings extensive, practical, hands-on experience in spear-heading the development and execution of complex processes and initiatives. Ensures seamless integration and successful execution of critical initiatives by overseeing the implementation of processes and strategies both within the department and with collaboration with external stakeholders.
Quality Assurance
- Maintains a comprehensive and up-to-date understanding of industry standards and best practices related to standard of care, payer policies, billing operations, payer/insurance carrier issues, and/or quality assurance processes in high-cost, complex therapeutics. Achieves this by reviewing payer communications, participating in webinars, conferences, seminars, Medicare training sessions, and external industry conferences. Engages in professional development and association activities to remain informed of emerging trends, regulatory changes and developments in the field. Proactively disseminates information to department and division leaders, ensuring the team remains well-informed and aligned with the latest advancements.
Other duties as assigned
MINIMUM EDUCATION & EXPERIENCE
- Bachelor's degree and 5 years of relevant experience required
- Master's degree preferred
- Or equivalent combination of education and experience
KNOWLEDGE, SKILLS AND ABILITIES
- Strong project management skills, with the ability to manage multiple programs simultaneously required
- Excellent communication, leadership, and relationship-building skills required
- Proficiency in data analysis and program evaluation required
- Proven experience in budget management and financial reporting preferred
- Knowledge of Insurance policies, access, approval processes preferred.
- Understanding of the pharmaceutical/ therapeutics industry preferred.
- Excellent written and verbal communication skills preferred.
- Ability to think strategically and operationally at the same time preferred.
- Ability to think critically and systemically preferred.
- Ability to analyze complex problems and formulate evidence-informed plans, solutions and courses of actions preferred.
- Knowledge of process and quality improvement methodologies/tools preferred.
- Ability to constructively challenge established ways of doing things and lead change preferred.
- Ability to analyze, understand, and utilize operational, clinical, and financial data preferred.
- Ability to establish and maintain cooperative working relationships with individuals at all levels of the organization preferred.
- Ability to promote and advance diversity, equity, and inclusion preferred.
- Ability to engage and influence team members, even in a matrix reporting structure preferred.
- Effective mentoring, coaching, and performance management skills preferred.
- Ability to work independently and meet deadlines preferred.
The University of Rochester is committed to fostering, cultivating, and preserving an inclusive and welcoming culture to advance the University’s Mission to Learn, Discover, Heal, Create – and Make the World Ever Better. In support of our values and those of our society, the University is committed to not discriminating on the basis of age, color, disability, ethnicity, gender identity or expression, genetic information, marital status, military/veteran status, national origin, race, religion, creed, sex, sexual orientation, citizenship status, or any other characteristic protected by federal, state, or local law (Protected Characteristics). This commitment extends to non-discrimination in the administration of our policies, admissions, employment, access, and recruitment of candidates, for all persons consistent with our values and based on applicable law.