Highlands Oncology began in 1996 with three physicians and a desire to change the face of oncology care in our community. Dr. Malcolm Hayward, Dr. Dan Bradford, and Dr. Thad Beck knew that patients do better at home, in the community where they live and work, and where their support system is already in place. In furthering that goal, Highlands has grown with the region from a single location 26 years ago, to 6 locations in Northwest and Northcentral Arkansas today employing more than 800 diverse team members.
As Northwest Arkansas continues to grow, so must the services and providers available in the region. Highlands Oncology is committed to remaining on the cutting edge to ensure our community has access to the very best cancer care. What we have is something quite unique right here in our own backyard with a caring multidisciplinary team focused on treating patients like family.
Job Summary: We are seeking a highly motivated and detail-oriented Clinical Pharmacist to join our team. In this role, the Clinical Pharmacist will be responsible for conducting clinical order reviews, managing prior authorizations, handling medication-related appeals, and drafting letters of medical necessity. The ideal candidate will have strong clinical knowledge, excellent communication skills, and a thorough understanding of medication therapy management in various healthcare settings.
Job Duties / Responsibilities:
1. Clinical Order Review:
· Review medication orders for appropriateness, accuracy, and safety.
· Ensure that prescriptions align with clinical guidelines, drug formularies, and patient-specific factors (e.g., allergies, comorbid conditions).
· Collaborate with physicians, nurses, and other healthcare providers to clarify and resolve medication-related issues.
2. Prior Authorization:
· Review and process medication requests for prior authorization (PA) according to payer guidelines and formularies.
· Communicate with healthcare providers and insurance companies to obtain necessary approvals for medications.
· Stay current with payer policies and clinical guidelines to ensure compliant and timely approvals.
3. Appeals Management:
· Handle and manage medication-related appeals for denied claims, including reviewing denial letters, gathering supporting documentation, and writing effective appeal letters.
· Collaborate with healthcare providers to ensure accurate and compelling case presentation.
· Ensure timely submission and follow-up on all appeals to resolve denial issues and secure medication access.
4. Letters of Medical Necessity:
· Draft clear and concise Letters of Medical Necessity (LMNs) to support insurance claims, demonstrating the clinical necessity of specific treatments or medications.
· Work with healthcare providers to gather appropriate clinical documentation and patient history to strengthen the case.
· Ensure LMNs are submitted in a timely manner and in compliance with insurance requirements.
5. Collaboration and Communication:
· Act as a liaison between healthcare providers, patients, insurance companies, and other stakeholders to ensure medication access and optimal patient care.
· Educate patients, physicians, and other healthcare providers on medication therapy management, formulary requirements, and insurance-related processes.
· Provide recommendations for alternative medications, when necessary, based on formulary restrictions.
6. Continuous Learning:
· Stay updated on the latest clinical guidelines, drug therapies, insurance policies, and industry trends related to prior authorization and appeals processes.
Participate in relevant professional development activities to enhance clinical knowledge and practice.
