Associate Care Navigator - REMOTE

Roles and Responsibilities

The Associate Care Navigator will conduct case management on behalf of the client and Southern Scripts ensuring specialty drug spend trend management savings in accordance with client agreement. This position will solve for the lowest cost drug while working in a high touch member centric manner, establishing a member relationship as a single point of contact.

This May Include Site Of Service Transitions And All Other RxCompass Component Saving Methods. This May Include Both Medical And PBM Claims.

Member Engagement Would Include Telephone, Written Correspondence, Fax, Or App. Member Engagements Are Typically Non-routine And May Require Deviation From Standard Screens, Scripts, And Procedures To Engage, Consult, And Educate Members And Providers By Delivering Individualized Programs Based Upon The Members Unique Needs And Preferences.

Key Areas Of Focus Include, But Not Be Limited To:

• Utilizes resources to assist members in understanding components of Southern Scripts products including claims, accumulators, usage, balances, and cost sharing.
• Support the success of Southern Scripts and our clients through the development, presentation, and implementation of member-centric solutions that drive down the cost of specialty medications, while maintaining a positive member experience.
• Supports department and client requirements in the meeting of turnaround times by working as needed to ensure all referrals are handled with a focus on a timely specialty drug service solution.
• Provides support in meeting client expectations regarding efficiency, service levels, privacy maintenance, and quality of decision-making.
• Responsible for maintaining compliance with ERISA, HIPAA, and client specific requirements.
• Works as part of the team to meet business unit objectives. Expects and accepts work in an environment where change agility is fundamental to success.
• Able to deal with a diverse customer base in a friendly manner, including medical and pharmacy office providers, hospitals, members, home infusion providers and other vendors inclusive of our drug cost saving efforts.
• Must display empathy and effective listening skills to deliver successful cost savings transitions of care.
• The ability to balance compassion, integrity, discretion, and sound judgement, with a strong desire to achieve and exceed expected metric.
• A proven background in medical/pharmacy benefits, particularly as these relate to specialty medications.

Requirements

High School degree, some college preferred or equivalent experience.

1-2 years experience with member engagement with PBM and Medical background.

1-2 years Specialty Pharmacy or PBM experience.

1-2 years CRM platform experience.

1-2 years experience collaborating with Clinical, Prior Authorization, sales, account management, senior executive, and various external client facing relationships.

Qualifications

Ability to work extended hours, weekends and holidays pursuant with industry demands, although this would not be typical.

Flexibility to understand, appreciate and embrace that this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee.