Care Coordinator

About the role

A typical day in the Care Coordinator role will include ownership of your patients cases from initiation to closure to include; benefit investigations, prior authorizations / denial appeals, determining financial qualifications for assistance programs and assisting patients or other callers/stakeholders through resolution (via email, inbound/outbound calls and using our patented technology, Lynk) by using your critical thinking skills and your knowledge of the program and industry rules and standards. This role requires a high level of ownership, attention to detail and patient focus and will put your problem-solving skills to the test!

Key Responsibilities

The responsibilities include, but are not limited to the following:

• Relationship Management
  • Builds trusted relationships with patients, prescribers, client stakeholders through proactive communication, timely and accurate execution of deliverables and demonstrated relentless passion for helping patients
  • Manages all relationships in a manner that adheres to healthcare laws and regulations
• Communications
  • Performs program welcome calls to patients
  • Performs post Benefits Investigation calls to patients and physicians explaining coverage options
  • Manages all client inquiries unable to be determined by client through reporting
  • Manages HCP inquiries, as applicable, pursuant to business rules
• Inbound Call Management
  • Manages inbound calls as directed by the program-approved FAQs
  • Triage patients to internal or external resources as appropriate
• Personalized Case Management
  • Provides personalized case management to patients and HCPs including outbound communication to HCPs and patients to communicate benefit coverage and next steps in obtaining coverage
  • Leverages electronic tools to identify benefits and payer coverage; completes manual benefit investigation as needed
  • Identifies and communicates patient's plan benefit coverage including the need for prior authorization, appeal, tier exception, and/or formulary exclusions
  • Uses electronic resources to obtain benefit coverage outcome and if needed, outbound call to payers and HCPs to follow up on proper submission and/or outcome
  • Coordinates nurse teach with field-based nurse educators, as applicable to program
  • Supports adherence services through coordination of nurse follow up, as applicable to program
  • Identifies peer support resources for patients
  • Coordinates shipment of product through patient assistance program and/or bridge program from the PharmaCord pharmacy
  • Proactively communicates needs for reverification of prior authorization or re-enrollment for patient assistance program
  • Reports adverse events, Product complaints, special situation reports and/or medical inquiries received in accordance with SOPs and the Business Rules
  • Documents all activities within the PharmaCord Lynk system in accordance with business requirements
  • Utilize Valeris' values as the driving force behind the team's success
  • On time adherence to training deadlines for all corporate policies and procedures
  • Ensure all SOPs are followed with consistency
  • Perform additional tasks or projects as assigned

Qualifications

Successful candidates possess the following personal attributes:

• Detail oriented
• Professional telephone etiquette
• Self-awareness of your own emotions and the potential impact on others
• Basic computer knowledge
• Ability to multitask effectively
• Ability to recognize emotions and their effects
• Sureness about self-worth and capabilities
• Manage disruptive impulses
• Maintain standards of honesty and integrity
• Takes responsibility for performance
• Adapts and handles change with flexibility
• Is innovative and open to new ideas
• Achievement driven; constant striving to improve or to meet a standard of excellence
• Aligns with the goals of the group or organization
• Ready to take initiative and act on opportunities
• Be optimistic and pursue goals persistently despite obstacles and setbacks
• Be service oriented and anticipate, recognize and meet needs of others, including patients and care partners
• Clear and concise communication
• Positive attitude!
• Bachelor's degree strongly preferred or equivalent experience required
• Customer service and healthcare industry experience is preferred but not required
• Ability to work an 8.5-hour shift between 8 am to 9 pm, Monday to Friday required
• Bi-lingual skills in Spanish and English are a plus
• Remote work eligibility is subject to all work from home criteria met and based on business need

Physical Demands & Work Environment

• While performing the duties of this job, the employee is regularly required to talk or hear
• The employee is frequently required to sit for long periods of time, use hands to type, handle or feel; and reach with hands and arms
• Prefer candidates who can type at least 35 words per minute with 97% accuracy
• Although very minimal, flexibility to travel as needed is preferred
• This job operates in a professional office environment
• This role routinely uses standard office equipment such as computers, phones, photocopiers, etc.

Benefits

We're committed to supporting the well-being and success of our team members. As part of our organization, full-time employees can expect:

• Medical, dental, and vision plans, including HSA- and FSA-eligible options, with Valeris contributing toward premium costs
• Additional health support, including telehealth and Employee Assistance Program (EAP) services
• Company match on Health Savings Account contributions
• Free Basic Life and AD&D coverage equal to your annual earnings, with a minimum of $50,000 and a maximum of $300,000
• Company-paid Short-Term Disability coverage, with the option to purchase Long-Term Disability
• 401(k) Retirement Savings Plan with 100% match on the first 5% you contribute, with immediate vesting
• Paid Time Off (PTO) and Sick Leave to support work-life balance
• Team members receive nine paid holidays plus two floating holidays
• Opportunities for advancement in a company that supports personal and professional growth
• A challenging, stimulating work environment that encourages new ideas
• Work for a company that values diversity and makes deliberate efforts to create an inclusive workplace
• A mission-driven, inclusive culture where your work makes a meaningful impact