Under direction of the Prescription Assistance Supervisor and within federal, state and local guidelines performs complex human services support work and eligibility determination for Prescription Assistance Programs (PAP). PAP/PCA will work cooperatively with other clinic staff to ensure that individuals served, with or without insurance, are seen in the MH Clinic by prescribers, and are able to receive the medications prescribed by center provider. This will include enrolling individuals in Rx Outreach and PAP and obtaining free or reduced cost medications from other programs, processing prior authorization requests, maintaining data in the pharmacy benefits management database, and preparing prescribers' schedules and needed documentation on a daily basis.

This position adheres to all applicable laws, regulations, policies, and procedures of HHSC, and DCMHMR. In addition, this position assists individuals who are indigent and without Medicaid or other prescription coverage to procure their medications from numerous pharmaceutical companies at no cost or low cost for psychiatric medications prescribed by DCMHMR prescribers. Works under moderate supervision, with limited latitude for the use of initiative and independent judgment.

Education, Training, and Experience

• High School Diploma or General Education Degree required.
• Prefer one year of college or work experience.
• Experience in medical office work or insurance preferred.

Registration, Certification, Licensure, and Other Qualifications

• Must have and maintain a background and criminal history free from any disqualifying offenses as outlined by the Texas Administrative Code (TAC) and the Health and Human Services Commission (HHSC).
• Must possess and maintain a valid driver's license and automobile insurance.

• Individuals with an out-of-state driver's license must be able to obtain a driver's license in the state of Texas within thirty (30) days.
• Successful completion of all position-specific training within thirty (30) days of employment is required.

Knowledge, Skills, and Abilities

• Skill in the use of computers, office equipment, and applicable software, including Microsoft Excel and electronic health records.
• Knowledge of psychiatric medications, medical and pharmaceutical terms, community and government service delivery systems, and of community welfare resources.
• Ability to communicate effectively and in a courteous manner, work with individuals with chronic mental illness, evaluate information, and perform basic arithmetic and data analysis.
• Ability to work at all center locations.
• Ability to display regular and reliable (in-person, if required) attendance.
• Understanding and practice of Trauma Informed Care principles.

Essential Duties

The following list outlines key responsibilities for the position; however, it is not exhaustive and does not encompass all responsibilities. Additional duties may be assigned as needed.

1. Generates, assists individuals in filling out, and submits applications for psychiatric medications for Prescription Assistance Program (PAP), Rx Outreach, and other free or discount med programs. Works with prescribers and clinic staff to secure needed scripts, signatures and other information needed to complete application. Educates staff and individuals served about PAP and other program requirements and timelines.
   • Responds promptly to requests for PAP, Rx Outreach, or other applications. Generates applications and obtains signatures while individuals are still in the center for priority medications.
   • Generate applications for PAP, Rx Outreach, or other program reenrollment for upcoming appointments and distributes to clinic staff and prescribers by the morning of the appointment.
   • Highlights are areas on applications that need to be completed or otherwise communicate instructions to appropriate staff.
   • Contacts Consumer Benefits Supervisor and/or case manager to request assistance in obtaining any additional income or other documentation needed.
   • Communicates with clinic staff, prescribers, and supervisor to coordinate how individuals will receive medications during application process and after PAP, Rx Outreach, or other free or discounted med program is approved.
2. Follows center PAP, medication, and med room procedures. Logs in all med packing slips and forms received.
   • Faxes or submits via online portal all forms as required.
   • Maintains an accurate and up to date database tracking system.
   • Monitors, reviews, and communications served individual eligibility or enrollment status changes to the individuals, authorized representatives, and appropriate staff as needed.
   • Checks in Rx Outreach, PAP, or other meds with a second staff member. Handles all meds according to center policies & procedures. Logs in all Rx Outreach, PAP, Americares, or other meds received in Med Data Services if applicable, and in pharmacy benefit management website/database according to clinic procedures.
   • Mails Rx Outreach, PAP, or other applications and other needed documents within 2 business days of completion.
   • Documents in Med Data Services each time an application is sent to the prescriber or individual served; an application is received back from the prescriber or individual; an application is sent to Rx Outreach, PAP, or other company; meds are received from Rx Outreach, PAP, or other company; or refills are ordered.
   • Documents any status updates in Med Data Services, such as requesting documents from individual served, temporary approval, individual served missed appointment, etc.
   • Documents orders for, receipt of, and any communication related to any other free or reduced cost medications in appropriate location.
3. Releases medications from PAP or other free or discounted medication programs to clients following clinic protocols.
   • Verifies all information is correct when releasing medications to clients.
   • Obtains client's signature when releasing medication to them.
   • Documents med release in pharmacy benefit management website/database.
   • Documents med release in client's record in electronic health record (EHR).
4. Identifies potentially eligible individuals to participate in Rx Outreach, PAP, or other med programs from schedules and based on information provided from clinic staff and prescribers. Obtains, verifies, and calculates income and resources to determine eligibility for Rx Outreach, PAP and other free/reduced cost medication programs.
   • Reviews upcoming schedules for Rx Outreach, PAP, and other med program applications that need to be done at least weekly.
   • Enters new eligible individuals and updates existing individuals' information into Med Data Services within 2 business days of receiving information from other staff.
   • Follows individual Rx Outreach, PAP and other programs' guidelines to determine individual's eligibility.
5. Updates individual's information in center's contracted pharmacy benefits manager (PBM) database. Enters overrides to allow medication claims to process as instructed in PBM.
   • Reviews lists of individuals enrolled in PBM as assigned and updates eligibility information as needed.
   • Enters new individuals into PBM as needed.
   • Enters overrides when needed per supervisor instructions in PBM.
6. Documents all calls from the nurse line and returns calls to individuals as appropriate, when assigned. Refers calls to nurses as needed.
   • Checks nurse line at least once an hour during business hours when assigned.
   • Documents nurse line calls accurately in message in electronic health record to Nurse In Charge (NIC), designated nurse, or other appropriate staff according to nurse line guidelines. Notifies staff in other departments of calls for them via chat or email.
   • Follows any instructions given by nurse or supervisor, and documents any actions taken in individual's chart.
7. Process prior authorization requests for prescription coverage in a timely manner.
   • Initiates prior authorization requests for medication coverage by phone, fax, or online within one business day when assigned.
   • Coverage determination results are reported to pharmacy and individual served and documented in the individual's record in a timely manner.
   • Processes appeals requests within two business days.
8. Completes audits and reports assigned, which may include but not limited to:
   • Medication funding source reports
   • Medication cost reports
   • Rx Outreach and PAP applications completed, returned, or in progress
   • Completes audits and reports within designated timeframes.
9. Communicates promptly with clinic management regarding any anomalies or questions about the audits/reports.
10. Maintains records of audits and reports on clinic shared drive.
11. Completes all documentation needed in clients' records in EHR in accordance with center policy.
12. Adheres to center's productivity standards as applicable.
13. Provides courteous, professional services at all times.
14. Provides appropriate customer service and demonstrates cultural sensitivity to all clients, staff, and visitors.
15. Demonstrates teamwork, dependability and problem-solving ability in a positive and collaborative manner.
16. Works collaboratively with clinic team, case managers and other center staff and, is mindful of how they may be coming across to others during collaboration and problem solving.
17. Demonstrates ability to work with others to identify opportunities and resolve issues to achieve group goal.
18. Takes initiative and provides input towards the solutions.
19. Performs additional duties as deemed necessary by department supervisor within designated timeframes, which may include:
20. Monitoring sample medication inventory
21. • 1. Counts and verifies inventory of samples and other medications kept at clinic with another staff member. Reviews samples and other medications at clinic for expired medications and gives to nurse for disposal.
    • Communicating with pharmaceutical company representatives.
      1. Contact pharmaceutical representatives when samples or information is needed.
    • Schedules pharmaceutical representatives or educational staff to present at monthly medical staff meetings.
    • Participate in eval phone rotation.
      1. Schedules evals following clinic protocol in a timely manner.
    • Prepares the schedules and individuals' charts for the prescribers daily as assigned. Ensures the documentation is completed accurately according to DCMHMR's policies and procedures.
      1. Prepares the prescriber's schedule by identifying items to be updated, including standing lab orders, consents, CANS/ANSA, and charity care assessment.
    • Identifies insurance status, and specific medication source if applicable (e.g. PAP).
    • Prepares necessary paperwork for scheduled individuals including crisis screenings, hospital discharge paperwork, CRU paperwork, lab results, and any documents that need to be signed (e.g. med consent).
    • Provides assistance in checking individuals served in and out during staff shortages, to help with coverage, or during other situations deemed necessary by supervisor.
      1. If trained to do so, checks individual's vital signs, records results, and reports any out-of-range readings to nurses.
    • Checks individuals in and out per protocol, including determining funding sources for medication, pharmacy to be used, entering lab orders, coordinating services for individuals with other staff, and any other actions needed.
    • Documents all interactions with the individual and actions taken appropriately
    • Practices workplace safety procedures.
    • Adheres to the use of Universal Precautions.
    • Provides emergency intervention when necessary according to Health and Human Services Commission (HHSC) and Center Policies and Procedures.
    • Provides verbal Prevention Management of Aggressive Behavior (PMAB) intervention correctly when necessary.
    • Provides Cardiopulmonary Resuscitation (CPR) in an emergency until other medical aid arrives.
    • Provides emergency and non-emergency first aid until professional aid arrives or as directed by a licensed medical professional.
    • Maintain necessary training as required by Denton County MHMR.
    • Provides emergency and non-emergency first aid effectively until first responders arrive.
    • Provides Cardiopulmonary Resuscitation CPR in an emergency until other medical aid arrives.
    • Provides verbal prevention management of aggressive behavior when necessary and does so effectively. Participates in the Center's Zero Suicide Initiative.

• Adheres to the Center Infection Control Plan.
• Informs appropriate staff of any safety hazard or issue promptly.

o Supports individuals experiencing a crisis by promptly connecting them with appropriate Center programs, such as the Mobile Crisis Outreach Team (MCOT), Psychiatric Triage, Crisis Prevention services, and/or other applicable resources. Ensure seamless coordination to facilitate timely intervention.

o Remains with individuals, when deemed safe, to provide support and maintain a calm environment until specialized crisis staff or emergency personnel arrive to take over intervention efforts. Adheres to safety protocols to prevent escalation of the crisis situation.

o Participates in debriefing sessions with the immediate supervisor or designated staff following a crisis event. Collaborate with the team to review the incident, identify lessons learned, and ensure all HHSC guidelines and Center policies are followed.