The Director of Specialty Care & Medicine Access oversees programs and initiatives to improve access to specialty care and medications for patients who face economic, cultural-linguistic, and other barriers to care. This role leads day-to-day program operations for specialty care and medicine access programs, sets the strategic direction for increasing impact, leads teams, and represents specialty care and medicine access programs on behalf of the PCC. Part of this role includes cultivating relationships with specialty care providers, pharmacy vendors, safety-net primary care health centers and providers, and other organizations that also provide access to specialty care and medicines. The Director of Specialty Care and Medicine Access is accountable to ensure reliable, evidence based, efficient, and safe patient centered processes in programs within the portfolio of oversight.
Telework
This position is approved to telework however staff member must be physically onsite 2-3 days a week for onsite meetings at the PCC Headquarters office in Silver Spring, Md. or at customer locations to perform certain duties. Note: PCC employees must reside in the following five states and District of Columbia: MD, VA, WVA, DE, PA. & DC. Relocation costs are not provided.
Essential Duties
1. Specialty Care Access Operations: Leads programs that provide adult and youth patients access to specialty care. Areas include but are not limited to:
- Oversees the day-to-day operations to ensure consistent staffing, efficient operations of the network referral processes, on-going resource development and problem-solving in coordination with PCC colleagues, staff at the partner primary care clinics, and contracted specialty care providers.
- Establishes goals and metrics for number and types of specialty care providers. With nurse reviewer, maintain and improve the referral criteria, referral process, timeliness of referrals, referral completion, no show rates, and service to the primary care clinics and patients.
- Ensures program performance reports, presentations, and budget reports are clear, accurate, timely, have consistent messaging, and provide analysis that drives good decisions.
- Ensures compliance with grant and contract requirements, and accountability for program results.
- Provides reporting and analysis of specialty care utilization across the population.
- Coordinates and facilitates meetings, maintain ongoing dialogue with, and ensure technical assistance and training are provided to the referring primary care clinics and specialist partners.
- Working in partnership with the team, and patient and provider stakeholders, manages and improves the workflow that enables quality care coordination and timely access to specialty care; Address operational issues as they arise, and ensure standard operating procedures are kept current and are followed.
2. Specialty Care Provider Network Development: Conduct specialty care provider recruitment and retention activities to ensure the providers necessary to meet specialty care access operational needs.
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Develops and executes provider recruitment and retention strategies for specialty care providers, in alignment with the established goals and metrics for number and types of specialty care providers.
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Networks with specialty care provider practices and other key vendors and partners to recruit and retain.
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Negotiates specialty provider MOUs, contracts, reimbursement rates and other collaborative agreements with all participating Project Access community and hospital-based specialty practices, and other providers as appropriate.
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Provides reporting and analysis of specialty care availability across the network.
3. Medicine Access Operations: Leads programs that provide patients access to generic medications and immunizations (procured per formulary for dispensing by primary care providers), name brand medications (obtained via national prescription assistance programs). Areas include, but are not limited to:
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Oversees the day-to-day operations to ensure consistent staffing, efficient operations of generic medication procurement, recall monitoring, and expiry audit processes, on-going resource development and problem-solving in coordination with PCC colleagues, staff at the partner primary care clinics, and contracted specialty care providers.
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Lead the evaluation and obtain recommendations to the generic medication formulary, immunization offerings, and cancer screening tests in collaboration with Medical Directors at the partner primary care clinics and subject matter experts.
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Ensures compliance with grant and contract requirements, and accountability for program results.
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Provides reporting and analysis of formulary and brand name medication usage for timely reporting internally and for external stakeholders.
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Coordinates and facilitates meetings, maintain ongoing dialogue with, and ensure technical assistance and training are provided to the prescribing providers partners.
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Ensure primary care and specialty care providers and patients are trained on referral processes for name-brand medications and are appropriately utilizing the prescription assistance services.
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Working in partnership with the team and patients, provider, and pharmaceutical stakeholders, manages and improves the workflow that enables access to medications through the formulary or prescription assistance; Ensure workflows, standard operating procedures are kept current and are followed.
4. Strategic Direction for the Specialty Care and Medication Access Programs: In consultation with the Senior Director of Healthcare Access defines the strategic direction of specialty care and medicine access services to maximize program impact. Areas include, but are not limited to:
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Drives program strategy for maximum impact using ongoing evaluation, process improvement, collaboration, and effective use of technology and data. Establishes program goals and metrics, tracks and reports performance, and develop strategies to improve program performance and the health outcomes of patients.
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Program oversight and reporting: Prepares monthly, quarterly, annual and ad hoc reports in a timely manner, and presents information to internal and external stakeholders.
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Leads program design and effectiveness: Plans details of programs including staffing models, workflows, cost estimates, and operating policies and procedures. Leads implementation of new initiatives putting in place the needed foundation for successful program launch, scale-up, and ongoing operations. Determines service expectations and capabilities and monitors key milestones. Guides the team and network of participating clinics to assess population needs and program effectiveness.
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Ensures the needs of all health centers, patients, primary care and specialty care providers are represented and considered when implementing programmatic processes.
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Resolve patient and provider complaints, update processes and standard operating procedures with lessons learned as appropriate.
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Develops and monitor budgets for programs within portfolio of oversight. Manages program implementation in accordance with PCC fiscal policies and procedures and regularly monitors budget to actual reports.
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Recommend action plans to address any significant variance in program expenditures and guard against cost overruns and underruns while ensuring resources are available to patients.
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Increasing growth and impact. Identifies areas of care need and looks for new opportunities to increase specialty and medicine access impact to serve the low-income, uninsured population. Conducts research to establish promising best practices, partnerships, and other approaches to address the need. Works with internal PCC partners to design, develop, implement, and source funding to address the needs.
5. Leads Teams: Creates a cohesive and productive work environment in order to achieve the required outcomes. Drives culture focused on exceptional customer service, efficiency, satisfaction of the clinic partners and patients. Areas include, but are not limited to:
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Hires, supervises, and develops department staff, including clinically licensed individuals, to ensure the workflows accomplish the department’s goals and objectives within budget.
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Provides clinical expertise to the specialty care nurse review of referrals, evaluation of medications for the formulary, and other areas which require clinical judgement and decision-making.
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Clearly communicates performance expectations, evaluates and provides direct reports with opportunities to develop skills and progress in their careers, and when necessary, implements and manages staff performance improvement plans.
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Ensures PCC policies and procedures are adopted and serves as a mentor and coach to direct reports willingly sharing knowledge and expertise and involving appropriate staff in planning, decision-making and problem solving.
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Escalates issues appropriately and seeks consultation from supervisor as needed to address team and program challenges.
6. Represents and Promotes the Specialty Care and Medicine Access Programs to External Organizations. Interacts with medical specialists and their staff, hospitals and co-workers. Coordinate efforts with the Catholic Charities Health Care Network (CCHCN), American Diversity Group (ADG), Alfa Pharmacy, partnering primary care clinics, and other organizations participating in the ecosystem that provides health care access for the low- income and uninsured. Maintains effective relationships with key internal and external stakeholders. (E.g. Montgomery County DHHS, MCAB, etc.)
Additional Responsibilities
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Collaborates and consults with Senior Director of Healthcare Access and peers covering behavioral health, clinical transformation, specialty care, medicine access, and primary care on strategies to advance PCC’s mission.
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Provide recommendations to Montgomery County Department of Health and Human Services and advocacy groups on program changes, and additional funding needs.
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With PCC Finance Department and contract holders, shepherd annual budgets and multiple budget modifications through the contract holders’ (e.g., local and state government) approval processes throughout the fiscal year. Provide justification and rationale for each budget modification to contract holders.
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Provides clinical expertise to PCC programs and activities, as needed.
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With PCC Fund Development Team, identify and direct grant-funded health care access projects, including contributing to written grant proposals, and assuring the development and tracking of workplans, management of grant funds and renewals, and submission of timely updates and project evaluations to funders and other stakeholders.
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Keeps abreast of environmental, legislative and regulatory policy changes related to specialty care and medicine access. Understands implications of policy changes for program delivery and updates program strategy and operations accordingly.
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Participates with PCC program management team members and in programmatic activities, internal work groups and committees as appropriate, as well as individual and organizational development activities.
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Other duties as assigned.
Skills and Abilities
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Demonstrated excellent oral and written communication skills and the ability to communicate effectively with a broad range of stakeholders including patients and families, clinicians, hospital administrators and public health officials, and PCC peers, staff and leadership.
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Ability to develop and maintain trusted relationships with primary and specialty care providers and pharmaceutical companies and advocate effectively on behalf of patients, families and underserved communities.
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Strong leadership skills, works collegially, engenders accountability and is a proven team builder; takes a consultative approach to establishing work plans and incorporates the viewpoints of senior leaders, staff, and peers.
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Ability to remain politically perceptive, work well under pressure and shift priorities based on contextual requirements.
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Excellent organizational and time management skills with the ability to meet deadlines, collaborate with staff and peers, manage multi-faceted projects with attention to detail.
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Strong research skills and the ability to makes data-driven decisions to support justifications for changes and recommendations.
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Appropriate clinical expertise to triage specialty care referrals and review a medication formulary.
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Sound financial leadership skills able to develop, forecast, and monitor programmatic budgets.
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Proven program or project management skills and an ability to organize, develop, implement, monitor, and evaluate professional workplan goals and performance objectives.
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Demonstrated ability to conceptualize, direct and implement program and workflow improvement strategies.
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Demonstrated effective computer skills, including Microsoft Office suite, database management and reporting, and electronic medical records.
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Strong data analysis and reporting skills.
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Self-motivated with the ability to work independently with minimal supervision.
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Some Spanish language ability preferred.
Education and Experience
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Clinical licensure (e.g. RN; NP; PA; MD; DO) required.
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Bachelor’s Degree required.
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4 to 8 years of health care delivery or healthcare administration.
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Prior experience working in a non-profit setting is preferred.
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Experience in primary care and/or specialty care required.
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Experience working with diverse, under-resourced populations preferred.
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Experience using electronic health records and case management software.
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Proficient in Microsoft Office suite of products (Outlook, Excel, Word, PowerPoint, SharePoint, Teams).
ADA Requirements
This job operates in a professional office environment. The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
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This role routinely uses standard office equipment such as computers, telephones, photocopiers, filing cabinets and fax machines.
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This is largely a sedentary role; however, some filing may be required.
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This would require the ability to lift files, open filing cabinets and bend or stand as necessary.
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Requires ability to learn new software applications as necessary.
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Must be able to lift up to 20 pounds.
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Must be able to travel locally.
Disclaimer
This job description indicates in general the nature and levels of work, knowledge, skills, abilities and other essential functions as covered under the Americans with Disabilities Act expected of an incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of an incumbent. An incumbent may be asked to perform other duties as required.
Primary Care Coalition is an Equal Opportunity Employer.
