Tentative Classification Standards issued by the Division of Classification & Compensation are shared with the operating agencies of State government for their consideration and comment. Accordingly, this document that you are viewing is subject to change and will be issued in final form at the completion of the review period.
Occ. Code 6303150
PHARMACY CONSULTANT, GRADE 25
York State Department of Civil Service
BRIEF DESCRIPTION OF CLASS
Positions in this title
series, independently or as a member of team (i.e., a multi-disciplinary survey
team, medical review or audit team, investigative team, or Central or Regional
Office regulatory program team), perform health surveillance, medical or
programmatic review, audit, investigations, and regulatory activities in
regards to pharmaceutical surveillance. Incumbents of these positions develop
and administer surveillance and health regulatory programs to ensure services
provided meet professional standards of practice, appropriateness, and quality
and comply with State, federal, and local statutes and regulations, and the
Life Safety Code.
These positions are
located at the Department of Health (DOH) and the Office of the Medicaid
Inspector General (OMIG).
PHARMACY CONSULTANT: advanced performance level;
Participate in or lead a team of professionals in the surveillance of health
care programs or residential programs with health care services, medical
review, audit, investigations, and/or regulatory related activities, with
specific attention to pharmaceutical issues.
Health Systems Specialists work on
teams and/or units involved with statewide surveillance, medical or
programmatic review, audit, investigations, and/or regulatory activities to
observe and evaluate patient or resident care; investigate and make
recommendations regarding licensure or certification; investigate fraud, waste,
and abuse in the Medicaid system; monitor corrective measures and levy
enforcement actions; and develop, review, recommend, and implement health policies
Participate in surveillance of health
care program or residential program with health care services, medical review,
audit, investigation, and/or regulatory related activities.
- Conduct and/or facilitate on-site
surveys independently or part of a team by observing and evaluating
patient/resident care against established standards; interviewing staff
and reviewing records; investigating incidents and/or patient/resident
complaints; and investigating and gathering information on unlicensed
heath care facility operations.
- Evaluate prescriptions and fiscal
orders, records and billings against applicable laws and regulations;
identify Medicaid fraud, waste, and abuse; and conduct utilization reviews
and audits for medical necessity.
- Make recommendations regarding
licensure or certification; surveillance, review, investigation and audit
findings; recommend corrective measures; and sanctions or enforcement
- Draft and/or review Statements or
Notices of Deficiencies, Plans of Correction, investigative reports, and
survey information against statewide standards for consistency and quality
- Provide staff support and gather
data needed to recommend enforcement or sanctions regarding facility and
provider licensing decisions.
- Clarify survey protocols for
health care providers and evaluate facility applications for the provision
Serve as a specialist and/or clinical
expert based upon licensure as a pharmacist.
- Provide training and oversight to
team members or unit staff regarding pharmacy laws and rules.
- Provide pharmaceutical expertise
to program area staff members, including pharmacological research and
consultation on projects relating to drugs, pharmacy and public health
- Provide technical assistance to
providers and may conduct provider training.
- Develop State policy and clinical
and programmatic guidelines for pharmacy surveillance
- Make recommendations on
enforcement/sanction actions against regulated or approved providers,
- Develop and implement procedures
and reporting systems for utilization review.
- Provide pharmaceutical expert
testimony in administrative hearings.
Develop, review, recommend, and
implement statewide health care program surveillance, medical review, audit, investigations,
and regulatory policies and procedures.
Plan, develop, and recommend regional
or statewide health service delivery system policies and procedures, taking
into account State, federal and local laws regulations, and program operations.
- Coordinate enforcement activities
in regard to health facility violations resulting from surveys, medical
reviews, audits, and/or investigations.
- Manage regulatory-related grants
and contracts for services and develop related policies and procedures.
- Administer programs that train,
license, and/or certify individual health or other regulated providers
including nursing home administrators, home health and personal care
aides, nurse aides, and funeral directors.
- Conduct health workforce planning
- Perform investigation and audits
of select pharmacy Medicaid providers for potential overpayments, fraud,
waste, or abuse.
- Participate in the on-site
evaluation of pharmacies as part of an audit team.
Review survey and compliance
investigation reports and facility plans of correction to ensure that
deficiencies are appropriately documented and meet federal and state
- Monitor regional survey
schedules, survey processes, and outcomes to insure that surveys are
completed in a timely manner.
- Monitor and evaluate regional
survey data to insure statewide and regional consistency in the
application and enforcement of laws, regulations, and other requirements.
- Analyze survey data to identify
patterns of non-compliance and make recommendations for regulatory or
policy changes or provider training to improve compliance and the quality
of health care.
- Conduct Central Office review and
recommendation on regional cases that meet criteria for movement to
- Assist in the development of
Statewide policies, and make recommendations for new or revised State
regulations, policies, and procedures.
- Develop and/or evaluate survey or
medical review protocols and procedures to implement new regulatory
requirements, address identified program needs or implement new program
- Work cooperatively with Central
and Regional Office managers to identify staff development needs, develop
training curriculum, and administer training programs.
- Serve as liaison between
appropriate State and Federal agencies with regard to pharmacy audits.
Open Competitive: current license and registration to
practice pharmacy in New York State and two years of post licensure experience
as a pharmacist.
NOTE: Classification Standards illustrate
the nature, extent and scope of duties and responsibilities of the classes they
describe. Standards cannot and do not include all of the work that might be
appropriately performed by a class. The minimum qualifications above are those
which were required for appointment at the time the Classification Standard was
written. Please contact the Division of Staffing Services for current
information on minimum qualification requirements for appointment or