TENTATIVE

Occ. Code 6303150

PHARMACY CONSULTANT, GRADE 25

New York State Department of Civil Service

Classification Standard

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).

DISTINGUISHING CHARACTERISTICS

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.

RELATED CLASSES

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 and procedures. 

ILLUSTRATIVE DUTIES

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 actions.
• Draft and/or review Statements or Notices of Deficiencies, Plans of Correction, investigative reports, and survey information against statewide standards for consistency and quality assurance.
• 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 of services.

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 concerns.
• 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, and/or recipients.
• 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 and monitoring.
• 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 requirements.

• 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 enforcement proceedings.
• 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 initiatives.
• 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.

MINIMUM QUALIFICATIONS

Open Competitive:  current license and registration to practice pharmacy in New York State and two years of post licensure experience as a pharmacist.

Date:  3/10

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 examination.