CASP Module 29, Section 2: Job Descriptions & Competency Frameworks
MODULE 29: YOUR WORKFORCE DEVELOPMENT PLAYBOOK

Section 29.2: Job Descriptions and Competency Frameworks

The “Package Insert” and “Monitoring Plan” for Your Staff.

SECTION 29.2

Job Descriptions and Competency Frameworks

Defining roles, expectations, and the architecture of excellence.

29.2.1 The “Why”: From Clinical Guideline to Organizational Guideline

As an experienced pharmacist, you are a master of guidelines. You live by the CHEST guidelines for anticoagulation, the NCCN guidelines for oncology, and the ADA guidelines for diabetes. You understand that these documents are the bedrock of safe, effective, and evidence-based patient care. They provide a common language, a set of defined expectations, and a framework for measuring quality.

Now, as a leader, you must translate that clinical mindset to an organizational one. A Job Description (JD) and a Competency Framework are not “HR fluff.” They are the foundational guidelines for your entire pharmacy operation. They are your primary tools for ensuring compliance, performance, and legal defensibility.

In a specialty pharmacy (SP), these documents are even more critical than in any other setting. Here’s why:

  • The Compliance Mandate: Accreditation bodies like URAC and the Accreditation Commission for Health Care (ACHC) do not just “recommend” these. They require them. During an audit, they will pull your job descriptions and competency checklists. They will then pull an employee’s training file and performance review. Their entire goal is to answer one question: “Does this employee know what they are supposed to do (the JD), have you proven they can do it well (the competency), and are you regularly checking (the evaluation)?” If you cannot produce this “paper trail,” you will fail your audit.
  • The Performance Mandate: How can you hold an employee accountable for “poor performance” if you never defined what “good performance” looks like? A JD is the “contract of expectations.” A competency framework is the “grading rubric.” Without them, all performance management is subjective, unfair, and ineffective. You move from “You’re not doing a good job” to “You did not meet competency 3.2, which requires PA submissions to have an error rate below 5%, and your audit showed a 15% error rate. Let’s create a plan to fix that.”
  • The Legal Mandate: A well-written JD is your single most important legal shield. It defines the “essential functions” of a role, which is a critical legal term for the Americans with Disabilities Act (ADA). If an employee requests an accommodation, the first question is, “Can they still perform the essential functions of the job, with or without this accommodation?” If your JD is vague, you have no legal ground to stand on. Similarly, in a wrongful termination lawsuit, the JD is Exhibit A for defining the expectations the employee failed to meet.

In short, you would never dose a high-risk drug without a monograph and a monitoring plan. You must not build a high-risk pharmacy without job descriptions and competency frameworks. They are the organizational equivalent.

Pharmacist Analogy: The “Package Insert” and “Monitoring Plan”

This is the most direct translation of your existing skills. Think of every role in your pharmacy as a new, high-risk specialty drug. How you manage that role is identical to how you manage a drug.

1. The Job Description is the “Package Insert” (Monograph)

When you get a new drug, you read the package insert. When you hire for a new role, you write the job description. They are the same document.

Package Insert Section Job Description Section The “Why” It’s the Same
Brand/Generic Name Job Title Specifically identifies the “agent” (e.g., “Clinical Pharmacist, Oncology”).
Indications for Use Job Summary What is this “drug” (role) approved to treat? (e.g., “To manage the clinical care of the oncology patient panel…”).
Dosage and Administration Essential Functions & Responsibilities How is the “drug” (role) administered? What does it do every day? (e.g., “Counsels 10 new patients per week…”).
Contraindications Minimum Qualifications Who cannot “take” this drug? (e.g., “Must have an active RPh license.” “Must not be on the OIG exclusion list.”).
Warnings & Precautions Compliance & Physical Demands What are the risks of using this “drug”? (e.g., “Must maintain HIPAA compliance.” “Must be able to lift 20 lbs.”).
2. The Competency Framework is the “Therapeutic Monitoring Plan”

You don’t just “give” a drug; you monitor it. You check troughs, LFTs, and INR. A competency framework is how you monitor your staff.

The Patient: A Clinical Pharmacist.
The Goal: Safe, effective patient management.
The Monitoring Plan (The Competency Framework):

  • “Trough Level”: Audit 5 of their clinical charts per quarter. (Goal: >95% adherence to documentation standards).
  • “SCr Check”: Direct observation of a new patient counseling call. (Goal: 100% of key counseling points covered).
  • “LFT Check”: Annual written exam on new drugs in their disease state. (Goal: >90% score).

By framing JDs and competencies this way, you move them from an “HR task” to a “clinical quality” task, a world where you are already an expert.

29.2.2 The Anatomy of an Accreditation-Ready Job Description

A vague or poorly constructed JD is a compliance time bomb. A robust JD is a multi-purpose tool for recruiting, training, and compliance. Every JD you write must be a formal document that includes several key, non-negotiable sections. You cannot just write a “help wanted” ad; you must build a formal organizational document.

Tutorial: The 8 Essential Components of a Job Description

Use this as your template for every role, from the Director of Pharmacy to the Delivery Driver.

  1. Job Title: Must be clear, specific, and standard. Avoid “internal” or “cutesy” titles. “Access Ninja” is bad. “Financial Access Specialist” is good. Also, include the department (e.g., “Clinical Pharmacist, Clinical Services Department”).
  2. FLSA Status & Job Type: Critical legal classification. Is this role Exempt (salaried, not eligible for overtime) or Non-Exempt (hourly, eligible for overtime)? Is it Full-Time or Part-Time? Your pharmacist is Exempt; your technician is Non-Exempt. Getting this wrong leads to massive wage-and-hour lawsuits.
  3. Reporting Structure: “Reports to: Clinical Services Manager.” This defines the chain of command and directly links to your org chart (from Section 29.1).
  4. Job Summary (The “Indication”): 2-4 sentences that define the role’s entire purpose. What is its “why”? (e.g., “The Access Specialist is responsible for ensuring all patients have clear, affordable access to therapy by completing all benefit verifications, prior authorizations, and financial assistance enrollments.”).
  5. Essential Functions & Responsibilities (The “Dosing”): This is the core. It must be a bulleted list of actions. Start every bullet with an action verb (e.g., “Verifies,” “Submits,” “Counsels,” “Documents,” “Manages”). This list should be comprehensive and cover the “Four Pillars” of their work:
    • Core Tasks: The 80% of their daily work.
    • Compliance Tasks: “Upholds all HIPAA/HITECH regulations,” “Adheres to all URAC/ACHC standards,” “Completes all required training.”
    • Team Tasks: “Collaborates with the clinical team…” “Communicates effectively with…”
  6. Qualifications & Requirements (The “Contraindications”):
    • Minimum Qualifications: The non-negotiable “must-haves.” (e.g., “High school diploma,” “Active state pharmacy technician license”).
    • Preferred Qualifications: The “nice-to-haves” that separate candidates. (e.g., “Certified Specialty Pharmacist (CSP),” “2+ years experience with CoverMyMeds”).
  7. Physical Demands & Work Environment: The ADA/OSHA compliance section. Be specific. (e.g., “Must be able to remain in a stationary position 80% of the time,” “Must be able to lift packages up to 30 lbs,” “Involves standard office environment with controlled temperatures.”).
  8. Employee Acknowledgment: A signature block at the bottom: “I, [Employee Name], have read, understood, and received a copy of this job description.” This is your legal proof that the expectations were set.

29.2.3 Masterclass: Sample Job Description Templates

Let’s build the JDs for the key roles we defined in our org chart. The following are comprehensive, accreditation-ready templates. Pay close attention to the “Instructional Designer’s Commentary” for the “why” behind the language.

Template 1: Clinical Pharmacist, Specialty Services

Job Title: Clinical Pharmacist, Specialty Services
Department: Clinical Services
Reports to: Director of Pharmacy / Clinical Services Manager
FLSA Status: Exempt
Job Type: Full-Time

Job Summary:

The Clinical Pharmacist is the therapeutic expert responsible for managing the care of specialty pharmacy patients to ensure safe, effective, and adherent use of complex medications. This role serves as the primary clinical point of contact for patients and providers, performing comprehensive initial assessments, developing and executing patient care plans, and conducting ongoing monitoring. The Clinical Pharmacist is directly responsible for optimizing therapeutic outcomes, driving medication adherence, and ensuring all clinical activities meet or exceed accreditation (URAC/ACHC) and payer standards.

Essential Functions & Responsibilities:
  • Performs comprehensive Initial Clinical Assessments for all new patients, including a full medication reconciliation, review of co-morbidities, allergy verification, and identification of all clinical and social barriers to care.
  • Develops, implements, and maintains an individualized, disease-state-specific Patient Care Plan (PCP) for every patient in their assigned panel, in accordance with accreditation standards.
  • Provides in-depth, “first-fill” counseling to all new patients, including education on the drug, its mechanism, side effect management, storage and handling, and injection training (via video or tele-health) as required.
  • Conducts detailed clinical re-assessments (refill adherence calls) for existing patients to monitor for side effects, assess adherence (via PDC/MPR calculation), and identify any new barriers or clinical interventions.
  • Performs the final clinical verification of all new and refill specialty prescriptions, ensuring therapeutic appropriateness, correct dosing, and alignment with the patient’s care plan.
  • Identifies, documents, and resolves all drug therapy problems (DTPs), including drug interactions, sub-optimal dosing, and therapeutic duplications.
  • Serves as the primary clinical liaison to prescribers, communicating vital patient information, lab results, and recommendations for therapy optimization (e.g., dose adjustments, alternative therapies).
  • Documents all patient interactions, clinical interventions, and care plan updates in the patient’s profile in a timely, accurate, and compliant manner.
  • Maintains expert-level knowledge in assigned disease states (e.g., Oncology, Rheumatology, MS) and stays current on new drugs, guidelines, and payer-level clinical policies.
  • Adheres strictly to all state and federal laws, including HIPAA, as well as all accreditation standards (URAC, ACHC) and internal Policies & Procedures (P&Ps).
  • Participates in the pharmacy’s Quality Management Program (QMP), assisting with data collection, audits, and performance improvement initiatives.
  • Provides after-hours clinical on-call support on a rotating basis.
Qualifications & Requirements:

Minimum Qualifications:

  • Doctor of Pharmacy (PharmD) or equivalent degree from an ACPE-accredited School of Pharmacy.
  • Active, unrestricted Pharmacist license in the pharmacy’s resident state.
  • Must be eligible for and obtain licensure in other states as required by business needs.
  • Must not be listed on the OIG, GSA, or any other state or federal exclusion list.

Preferred Qualifications:

  • 2+ years of experience in a specialty, hospital, or managed care pharmacy setting.
  • Certified Specialty Pharmacist (CSP) credential or board certification (e.g., BCPS, BCOP).
  • Completion of a PGY1 or PGY2 residency.
  • Experience with disease-specific patient management (e.g., Oncology, Hepatitis C).

Physical Demands & Work Environment:
  • Must be able to remain in a stationary position for extended periods (80%+ of the time) to perform computer-based work and telephonic patient consultations.
  • The person in this position needs to occasionally move about inside the office to access file cabinets, office machinery, etc.
  • Constantly operates a computer and other office productivity machinery, such as a calculator, copy machine, and computer printer.
  • The ability to communicate information and ideas so others will understand. Must be able to exchange accurate information in these situations (telephonic and in-person).
  • Work is performed primarily in a standard, temperature-controlled office environment.

Instructional Designer’s Commentary:

Notice the language. It’s built for compliance. Phrases like “in accordance with accreditation standards,” “develops… Patient Care Plan (PCP),” “documents all… interventions,” and “OIG… exclusion list” are not just descriptive; they are audit keywords. You are handing an auditor a JD that maps directly to their checklist. The “Essential Functions” are not just “verifies scripts”; they are a detailed list of the entire clinical workflow, from assessment to intervention to documentation. This sets a high bar for performance and creates a rock-solid compliance document.

Template 2: Access Specialist (Prior Authorization)

Job Title: Access Specialist (PA Specialist)
Department: Access Services
Reports to: Access Services Manager
FLSA Status: Non-Exempt
Job Type: Full-Time

Job Summary:

The Access Specialist is responsible for managing the end-to-end reimbursement and financial access workflow for all new and existing specialty patients. This role acts as a patient advocate and “financial engineer,” ensuring that therapy is secured, approved, and affordable. The Specialist will perform detailed benefit verifications (BVs), complete and submit all prior authorizations (PAs), and enroll eligible patients in financial assistance programs (copay cards, foundations, or grants).

Essential Functions & Responsibilities:
  • Initiates and completes comprehensive Benefit Verifications (BVs) for all new patients to determine coverage details, including medical vs. pharmacy benefit, deductible/coinsurance/OOP maximums, and PA requirements.
  • Manages the entire Prior Authorization (PA) process from start to finish: gathers all necessary clinical documentation (labs, chart notes, diagnosis codes) from provider offices, accurately completes payer-specific PA forms, and submits via the most efficient portal (e.g., CoverMyMeds, Surescripts, payer portal).
  • Aggressively tracks all pending PAs, performing regular follow-up with payers and providers to ensure a final determination is received in the shortest possible time.
  • Manages all PA denials. Analyzes denial reasons, gathers new supporting evidence, and initiates and tracks the appeals process, including facilitating Peer-to-Peer reviews for providers.
  • Serves as the subject matter expert on financial assistance. Identifies and enrolls eligible patients in manufacturer copay card programs.
  • For Medicare and uninsured/underinsured patients, identifies and secures funding from charitable foundations (e.g., PAN Foundation, HealthWell, GoodDays), managing the entire grant application process.
  • Maintains an expert-level understanding of payer-specific clinical policies, step-therapy requirements, and preferred drug lists for key specialty disease states.
  • Clearly and empathetically communicates with patients to explain their benefits, their out-of-pocket costs, and the status of their authorization.
  • Documents all activities, statuses, and communications in the patient’s profile with 100% accuracy to ensure a clear audit trail.
  • Adheres strictly to all state and federal laws, including HIPAA, as well as all accreditation standards (URAC, ACHC) and internal P&Ps.
Qualifications & Requirements:

Minimum Qualifications:

  • High school diploma or GED.
  • 2+ years of experience in a pharmacy, medical office, or healthcare reimbursement role.
  • Must not be listed on the OIG, GSA, or any other state or federal exclusion list.

Preferred Qualifications:

  • Active, unrestricted state Pharmacy Technician license and/or CPhT certification.
  • 3+ years of experience dedicated to prior authorizations and medical billing.
  • Demonstrated expertise with PA portals (CoverMyMeds, etc.) and specialty pharmacy software.
  • Experience with medical benefit billing (J-codes, “buy and bill”).

Physical Demands & Work Environment:
  • Must be able to remain in a stationary position for extended periods (80%+ of the time) to perform computer-based work and telephonic payer/provider/patient contact.
  • Constantly operates a computer, multi-line phone, and other office machinery.
  • The ability to communicate information and ideas so others will understand. Must be able to exchange accurate information in these situations (telephonic and in-person).
  • Work is performed primarily in a standard, temperature-controlled office environment.

Instructional Designer’s Commentary:

This JD is built for a specialist, not a generalist. The language is active and investigative: “aggressively tracks,” “analyzes denial reasons,” “identifies and secures funding.” You are defining a role that is proactive, not reactive. Note the distinction between “Minimum” and “Preferred” qualifications. You can hire someone with medical billing experience, but you prefer a CPhT. This widens your talent pool while maintaining a high standard. This JD tells a candidate, “This is a complex, high-stakes finance and investigation job,” which is exactly what it is.

Template 3: Patient Care Coordinator (PCC)

Job Title: Patient Care Coordinator
Department: Clinical Services
Reports to: Clinical Services Manager
FLSA Status: Non-Exempt
Job Type: Full-Time

Job Summary:

The Patient Care Coordinator (PCC) is the primary logistical and adherence support contact for a panel of specialty pharmacy patients. The PCC is responsible for managing all scheduled refill follow-ups, proactively assessing medication adherence, and identifying non-clinical barriers to care. This role functions as the “quarterback” for the patient’s logistical needs, coordinating deliveries, assessing supply needs, and triaging all patient inquiries to the appropriate (Clinical or Access) department, ensuring a seamless, high-touch patient experience.

Essential Functions & Responsibilities:
  • Manages a patient queue to perform scheduled “refill adherence” calls in a timely manner.
  • Performs structured adherence assessments during each call, including confirming current supply-on-hand, calculating next refill date, and identifying any missed or held doses.
  • Assesses patients for non-clinical barriers to care, such as financial difficulties, transportation issues, or social determinants of health.
  • Triages all identified barriers to the correct department for resolution (e.g., financial issues to Access team; clinical/side effect issues to Clinical Pharmacist).
  • Coordinates all refill shipments, confirming the patient’s current address, scheduling a delivery date, and ensuring all supplies (sharps containers, alcohol swabs) are included.
  • Serves as the primary “inbound” contact for patient questions, providing best-in-class customer service and directing inquiries to the appropriate licensed professional as needed.
  • Maintains meticulous and accurate documentation of all patient communications and adherence assessments in the patient’s profile.
  • Assists the Clinical Pharmacist by gathering patient data and managing non-clinical follow-up tasks.
  • Monitors patient adherence (PDC) reports and escalates at-risk patients to the Clinical Pharmacist for intervention.
  • Adheres strictly to all state and federal laws, including HIPAA, as well as all accreditation standards (URAC, ACHC) and internal P&Ps.
Qualifications & Requirements:

Minimum Qualifications:

  • High school diploma or GED.
  • 2+ years of experience in a high-touch customer service role (e.g., call center, healthcare).
  • Exceptional verbal communication, listening, and interpersonal skills.
  • Demonstrated ability to be empathetic, patient, and professional.
  • Must not be listed on the OIG, GSA, or any other state or federal exclusion list.

Preferred Qualifications:

  • Active, unrestricted state Pharmacy Technician license and/or CPhT certification.
  • 1+ years of experience in a pharmacy setting.
  • Bilingual (e.g., Spanish-speaking).

Physical Demands & Work Environment:
  • Must be able to remain in a stationary position for extended periods (80%+ of the time) to perform computer-based work and telephonic patient contact.
  • This is a high-volume telephonic role requiring constant use of a headset and computer.
  • The ability to communicate information and ideas so others will understand. Must be able to exchange accurate information in these situations (telephonic).
  • Work is performed primarily in a standard, temperature-controlled office environment.

Instructional Designer’s Commentary:

The key here is triage and adherence. This JD is intentionally non-clinical. The PCC’s job is to assess and triage, not to solve clinical or financial problems. This is a critical distinction that protects you from compliance issues (i.e., a technician practicing pharmacy). The language is all about “customer service” and “logistics”: “high-touch,” “seamless experience,” “coordinates deliveries,” “triages.” You are hiring for empathy, organization, and communication. You can teach them the “pharmacy” part, but you must hire for the “care” part.

Template 4: Adherence Nurse (RN)

Job Title: Adherence Nurse (RN)
Department: Clinical Services
Reports to: Clinical Services Manager
FLSA Status: Exempt
Job Type: Full-Time

Job Summary:

The Adherence Nurse (RN) is a licensed clinical professional who provides high-touch support to specialty pharmacy patients, with a focus on patient education, injection training, and clinical side effect triage. This role works collaboratively with the Clinical Pharmacist to execute the Patient Care Plan, providing clinical assessments and interventions that are within a nurse’s scope of practice. The Adherence Nurse is a key educational resource for patients, empowering them to manage their therapy effectively and promoting adherence by addressing clinical barriers to care.

Essential Functions & Responsibilities:
  • Provides patient-facing, hands-on (or via video) injection training for new-to-therapy patients on complex self-injectable medications.
  • Serves as a primary clinical point of contact for inbound patient calls regarding side effects, missed doses, or other clinical inquiries.
  • Performs structured nursing assessments to triage patient-reported side effects, differentiating between mild/manageable effects and severe adverse events requiring pharmacist or prescriber escalation.
  • Provides patient education on side effect management techniques (e.g., pre-medication, injection site rotation, hydration).
  • Works with the Patient Care Coordinator (PCC) team to manage adherence follow-up calls for high-risk or clinically complex patient panels.
  • Assists the Clinical Pharmacist with data gathering for care planning, including calling patients to confirm lab results or recent hospitalizations.
  • Collaborates with prescribers’ office staff (e.g., office RNs, MAs) to coordinate patient care, report adverse events, and facilitate refills.
  • Develops and maintains patient-facing educational materials (e.g., tip sheets, injection guides) under the supervision of the Clinical Pharmacist.
  • Documents all patient interactions, clinical assessments, and interventions in the patient’s profile in a clear, concise, and compliant manner.
  • Adheres strictly to all state and federal laws, including HIPAA, as well as all accreditation standards (URAC, ACHC) and internal P&Ps.
Qualifications & Requirements:

Minimum Qualifications:

  • Associate’s Degree in Nursing (ADN) or Bachelor of Science in Nursing (BSN).
  • Active, unrestricted Registered Nurse (RN) license in the pharmacy’s resident state.
  • 2+ years of clinical experience in a hospital, clinic, or home health setting.
  • Must not be listed on the OIG, GSA, or any other state or federal exclusion list.

Preferred Qualifications:

  • BSN or higher.
  • Experience in relevant disease states (e.g., Oncology, GI, Neurology).
  • Experience with patient education and tele-health.
  • Case management certification.

Physical Demands & Work Environment:
  • Must be able to remain in a stationary position for extended periods (80%+ of the time) to perform computer-based work and telephonic/video patient contact.
  • Constantly operates a computer, multi-line phone, and video conferencing equipment.
  • May be required to demonstrate injection techniques, requiring manual dexterity.
  • The ability to communicate clinical information and ideas so others will understand. Must be able to exchange accurate information in these situations (telephonic and video).
  • Work is performed primarily in a standard, temperature-controlled office environment.

Instructional Designer’s Commentary:

This role is a “force multiplier” for your Clinical Pharmacist. The JD is written to define its scope in relation to the RPh and the PCC. The RN can do things a PCC (tech) cannot (perform clinical triage, provide side effect management advice) but does not replace the RPh (who is still responsible for the final care plan, drug therapy problem resolution, and final script verification). This role is perfect for injection training and side effect triage, which frees up your most expensive resource—the pharmacist—to focus on the most complex clinical interventions and prescriber consultations.

29.2.4 The Competency Framework: Your Accreditation “Monitoring Plan”

You now have your “Package Inserts” (JDs). It’s time to build your “Monitoring Plans” (Competency Frameworks). A competency framework is a formal, auditable system to train, evaluate, and document that your staff can perform the essential functions of their job safely and effectively.

This is not optional. Accreditation bodies (URAC/ACHC) mandate that you have a program for assessing and documenting staff competencies, both upon hire (initial) and on a regular basis (typically annual).

The Accreditation Mandate: “Show Me the Proof”

An auditor will sit down and say, “I see you have an Access Specialist named Jane Doe. Please provide me with the following:”

  1. Jane’s job description.
  2. Your organization’s competency framework for that role.
  3. Jane’s initial competency assessment from her first 90 days (her “training checklist”).
  4. Jane’s most recent annual competency assessment.

If you cannot produce all four of these documents, with matching signatures and dates, you will receive a deficiency. Your competency framework is the “study guide, the test, and the graded paper” all in one. It is your objective proof that your team is qualified.

Anatomy of an Effective Competency Framework

A good framework is a simple checklist or table that breaks each role down into two types of competencies and three evaluation methods.

  • Core Competencies: Everyone in the pharmacy must demonstrate these.
    • Examples: HIPAA & Patient Confidentiality, Hand Hygiene & General Safety, Use of the Core Pharmacy Software, Customer Service Standards, Emergency Preparedness.
  • Role-Specific Competencies: These are tied directly to the “Essential Functions” of the job description.
    • Examples: “Benefit Verification” (for Access), “Clinical Assessment” (for RPh), “Refill Adherence Call Script” (for PCC).

The Three Evaluation Methods (How to “Prove” Competence)

You cannot just “say” someone is competent. You must prove it. You need a mix of methods to test different skills.

  1. Written Exam / Knowledge Test:
    • What it’s for: Testing factual, “book” knowledge.
    • Examples: An annual 10-question HIPAA quiz. A “Top 10 Drugs” quiz for a new clinical pharmacist. A “Payer Terminology” quiz for a new Access Specialist.
    • Documentation: The graded, signed quiz is filed in the employee’s file.
  2. Direct Observation / “Check-Off”:
    • What it’s for: Testing a “live” skill or process.
    • Examples: A manager listens in (with a-monitoring form) on a PCC’s adherence call. A clinical manager observes a pharmacist’s “first-fill” counseling call. The PIC watches a technician correctly pack a cold-chain box.
    • Documentation: A “Competency Assessment Checklist” signed by the manager (e.g., “Observed employee perform injection training: 10/10 steps correct.”).
  3. Audit / Work Product Review:
    • What it’s for: Testing skills that produce a “paper trail.”
    • Examples: A manager audits 5 of a specialist’s PA submissions for accuracy. A clinical manager reviews 3 of a pharmacist’s “Initial Assessments” for completeness.
    • Documentation: The “Audit Form” with the score (e.g., “5/5 PAs submitted with correct diagnosis code and clinical notes attached.”) is signed and filed.

29.2.5 Masterclass: Sample Competency Frameworks (The “Monitoring Plan”)

The following tables are your auditable competency checklists. You would copy this table, create a formal document, and use it for *every* new hire (as a training guide) and *every* existing employee (as an annual review tool).

Competency Framework: Clinical Pharmacist

Competency Domain Specific Competency Evaluation Method(s) Frequency
Core Competencies Demonstrates 100% adherence to HIPAA and patient confidentiality policies. 1. Annual Written Exam (10-question quiz).
2. Audit (No documented breaches).		 Initial & Annual
Clinical Knowledge Demonstrates expert knowledge of therapeutics for assigned disease state(s). 1. Written Exam (Disease state & drug quiz).
2. Case Study Review (Develops appropriate care plan).		 Initial & Annual
Patient Assessment Performs a comprehensive Initial Clinical Assessment for new patients. 1. Direct Observation (Manager listens to a live call).
2. Audit (Review of 5 “Initial Assessment” forms for completeness).		 Initial & Annual
Patient Counseling Effectively counsels new patients on all required elements (side effects, storage, admin). 1. Direct Observation (Manager listens to “First Fill Counseling” call).
2. Patient Satisfaction Survey feedback.		 Initial & Annual
Care Planning Develops and maintains a compliant, individualized Patient Care Plan (PCP). 1. Audit (Quarterly review of 5 PCPs from patient panel). Quarterly
Intervention & DUR Identifies and resolves Drug Therapy Problems (DTPs). 1. Audit (Review of documented clinical interventions).
2. Case Study Review.		 Initial & Annual
Documentation Documents all patient encounters clearly, concisely, and in accordance with P&Ps. 1. Audit (All chart/audit reviews include a check for documentation quality). Initial & Annual

Competency Framework: Access Specialist

Competency Domain Specific Competency Evaluation Method(s) Frequency
Core Competencies Demonstrates 100% adherence to HIPAA and patient confidentiality policies. 1. Annual Written Exam (10-question quiz).
2. Audit (No documented breaches).		 Initial & Annual
Payer Knowledge Articulates the difference between Medical and Pharmacy benefits and key terminology (deductible, coinsurance). 1. Written Exam (Terminology quiz).
2. Case Study Review (Correctly identifies benefit structure).		 Initial & Annual
Benefit Verification Performs an accurate and complete Benefit Verification (BV) call/check. 1. Direct Observation (Manager listens to a live BV call).
2. Audit (Review 5 completed BV forms for accuracy).		 Initial & Annual
PA Submission Submits a complete and accurate Prior Authorization with all required clinical documentation. 1. Audit (Manager reviews 10 PA submissions).
2. Metric Review (First-pass approval rate).		 Initial & Annual
Appeals Process Effectively manages a PA denial, identifies the appeals path, and facilitates a Peer-to-Peer. 1. Case Study Review (Give a denied case and have them write the appeal letter). Initial & Annual
Financial Assistance Identifies and successfully enrolls patients in all eligible copay card and foundation programs. 1. Audit (Review 10 patient profiles for missed financial assistance opportunities).
2. Metric Review (Average patient OOP).		 Initial & Annual
System & Documentation Accurately documents all PA statuses, communications, and financial aid in the patient profile. 1. Audit (All audits include a check for documentation quality and timeliness). Initial & Annual

Competency Framework: Patient Care Coordinator (PCC)

Competency Domain Specific Competency Evaluation Method(s) Frequency
Core Competencies Demonstrates 100% adherence to HIPAA and patient confidentiality policies. 1. Annual Written Exam (10-question quiz).
2. Audit (No documented breaches).		 Initial & Annual
Customer Service Demonstrates empathy, professionalism, and adherence to phone scripts. 1. Direct Observation (Manager listens to 3 live calls).
2. Patient Satisfaction Survey feedback.		 Initial & Quarterly
Adherence Assessment Correctly performs adherence check (confirms supply, identifies missed doses) during refill call. 1. Direct Observation (Manager listens to 3 live calls using a checklist). Initial & Quarterly
Triage & Escalation Correctly identifies and triages clinical and financial barriers to the appropriate department (RPh or Access). 1. Direct Observation (Manager listens to 3 live calls).
2. Audit (Review 10 call logs for correct triage).		 Initial & Annual
Logistics & Scheduling Accurately schedules deliveries, confirms address, and includes all necessary supplies. 1. Audit (Review 10 scheduled delivery orders for accuracy).
2. Metric Review (e.g., shipping error rate).		 Initial & Annual
System & Documentation Accurately and efficiently documents call outcomes and next steps in the patient profile. 1. Audit (Review 10 call logs for documentation quality). Initial & Annual

29.2.6 Putting It All Together: The Employee Lifecycle

Your Job Descriptions and Competency Frameworks are not static documents that sit in a folder. They are the spine of your entire workforce strategy. They connect every single phase of an employee’s journey, from their first interview to their promotion.

By building these documents first, you create an objective, fair, and scalable system for managing your team. This is how you build a culture of excellence and ensure that every patient receives the same high standard of care, regardless of who is handling their case.

The JD & Competency-Driven Employee Lifecycle

1. RECRUITING

The Job Description is the source of truth for your job posting. The “Qualifications” section is your automated filter for resumes.

2. INTERVIEWING

Your Competencies are your interview questions. Instead of “What’s your weakness?” you ask, “Tell me about a time you handled a complex PA denial” (tests the “Appeals” competency).

3. ONBOARDING

Your Competency Framework is your 90-day training plan. The goal of onboarding is to get a signature on every single competency, proving the employee is trained and “checked-off.”

6. CAREER LADDERING

Promotion becomes objective. A “PCC 1” is promoted to “PCC 2” when they have mastered all PCC 1 competencies and demonstrated 3/5 of the PCC 2 competencies (e.g., “training new hires”).

5. CORRECTIVE ACTION

This is no longer personal. A warning is now: “You are not meeting the ‘Documentation’ competency as defined in your job description. Here is a 30-day plan to meet it.”

4. PERFORMANCE REVIEW

The annual review is no longer subjective. You simply go down the Competency Framework and rate the employee (1-5) on each one, providing documented examples from your audits.