Fawn Ailsworth, RN PACS

Assess individual needs of 50+ patients and develop an appropriate education and resource plan of action, considering the patient's family and team of healthcare providers to empower the patient to become their own advocate

• Educate the patient on TEPEZZA coverage based on their benefits and the steps needed to gain prior authorization to ensure understanding of the process for medication access
• Provide information on co-pay assistance programs, national foundations, and free drug programs by sharing information to patients as appropriate and needed
• Provide proactive education to prescribers and sites of care upon patient enrollment on coverage for Horizon rare disease therapies, common prior authorization requirements, and coding and billings requirements
• Provide access and reimbursement education based on the enrolled patient's TEPEZZA benefits to physician offices and sites of care
• Educate the physician office and/or SOC on TEPEZZA coverage based on the patient's benefits and the steps needed to gain prior authorization to ensure understanding of the process for medication access
• Investigate access challenges pre and post-infusion
• Work closely with the Horizon cross functional team including Case Managers, the Site of Care team, market access, matrix partners and external vendors

• Educated HCPs and their staff on matters related to reimbursement, access and coverage to facilitate appropriate patient access.:
• Analyzed access/reimbursement challenges and provided education viable opportunities and options to secure pull-through
• Fostered solution-oriented environment with matrix partners to provide best pathways to treatment

• Empowered patients by providing patient-centric education and resources for specialty oral oncolytic product and diseases it treats
• Helped patients navigate complex reimbursement issues with Medicare, Medicaid, Commercial insurance plans, and alternative funding/financial assistance programs
• Built strong relationships with patients and their caregivers throughout patient support program enrollment.

• Supported Project Lead in daily process, call handling, and operational oversight of CRM and telephony system
• Provided technical support to staff of Nurse Educators
• Provided client-required training to staff covering disease, drug, and operational processes
• Conducted Motivational Interview training of staff, ensuring successful completion
• Assisted Project Lead in development of business rules and training timelines
• Completed monthly Quality Reporting for staff to determine health of patient support program
• Audited Nurse Educator interactions to ensure company compliance, adherence to business rules, and patient/caregiver satisfaction.

• Managed ASTC, Tennessee and National regulations for surgical suite/reproductive health clinic, ensuring successful performance and boosting productivity of all clinical staff
• Executed pristine outline for quality improvement and infection control programs ensuring criteria meets accreditation and state and national regulations
• Designed clinic's LARC (Long-Acting Reversible Contraception) grant program guidelines for buy & bill, specialty pharmacy access, and referral generation
• Serve as clinic's point of contact with pharmaceutical manufacturers' sales force
• Developed and implemented effective corrective action plan and areas of opportunities for colleagues
• Instrumental in delivering quality results serving as agency's HIPAA, OSHA and Compliance officer, EMR Champion and Project Lead
• Efficaciously incorporated essential risk management, reimbursement, and financial management into operational systems.

• Developed valuable relationships, ensuring client satisfaction with essential elements of hub patient support program which included management of virtual and onsite telephonic nursing and reimbursement support for cardiometabolic disorder therapy
• Improved operations by serving as reimbursement and telephonic nurse educator resource for staff and client
• Assisted in development of clinical workflows and call scripting for nurse educators
• Worked with client to create telephonic nurse call standard operating protocols
• Maximized productivity by implementing departmental plans and priorities to address resource and operational changes
• Trained field and patient access liaisons on processes surrounding patient financial assistance and alternative funding to provide patient access to specialty drug
• Served as resource for intake team regarding Managed Care, Commercial, and Government Payers.

• Enhanced communications as primary resource for clinical and technical questions while providing guidance regarding customer service expectations, day-to-day operations, and adherence to established Standard Operating Procedures (SOP) to telephonic nursing educators for an osteoporosis therapy
• Expertly handled resolution of escalated issues from physicians, sales team, and patients
• Delivered exceptional feedback as Internal Quality and Call Monitor of employees, providing coaching and mentoring where needed using Verint and Avaya telephony systems
• Managed clinical staff for manufacturer patient support program, overseeing workloads, staffing needs, and ensuring daily assignments were carried out efficiently
• Successfully achieved post-marketing safety by reviewing and submitting information related to adverse events and product complaints
• Prepared and presented information for Quarterly Business Review to clients and internal stakeholders.

• Utilized motivational interview techniques to perform risk and adherence assessments for patients utilizing specialty injectable and infused therapies
• Provided disease state education and injection training to patients with chronic, rare diseases such as: multiple sclerosis, rheumatoid arthritis, growth hormone deficiencies, Hepatitis C, and hematological disorders
• Spearheaded successful coordination of home infusion and outpatient intravenous therapies
• Managed onboarding development and training of new nurses to therapy specific tasks per manufacturer contract requirements
• Served as liaison between physicians and payors in the appeal process to acquire medication denied by insurance
• Expertly performed clinical review and prior authorizations for numerous specialty drugs utilizing criteria set forth various payors.

• Delivered first-class care to medical/surgical patients throughout various units in the hospital
• Managed coordination of services and treatment including surgery pre-operative preparation, discharge teaching, and development of plans of care.

• Successfully oversaw and delivered total patient care for 2-3 critically ill preterm/term infants
• Executed specific coordination of services and treatments, ventilator/oscillator management, notified physicians of changes, telemetry and hemodynamic monitoring, discharge teaching, and provided education to families regarding care needs and the patient's disease process.

• Boosted client satisfaction by implementing total patient care for 1-2 critically ill patients in a neurological setting
• Instrumental in ventriculostomy management, intracranial pressure monitoring, telemetry and hemodynamic monitoring, and titration of vasoactive and sedative medications.

• Completed client benefit verification and prior authorization research and communicated findings to physician offices and patients
• Analyzed and explored financial support programs such as copay cards and patient assistance programs to eliminate financial barriers of medication cost
• Addressed claim denials with payers to obtain specialty drug coverage for clients
• Performed reimbursement functions for buy & bill and PBMs for specialty drugs by submitting claims and resolving complex reimbursement issues for Medicare, Medicaid, and commercial payors.