Case Manager

About the role

We are seeking a dedicated Benefits Investigation Specialist to join our dynamic team. Your role will be pivotal in ensuring patients have access to essential medications by engaging with Medical Insurance Payers and Pharmacy Benefit Managers to identify and document coverage options.

Responsibilities

• Takes the lead to manage the Care Coordination process within an assigned territory.
• Uses tact and independent judgment to balance patient and physician needs with the business realities and necessities of the program.
• Establishes and maintains professional and effective relationships with all internal and external customers.
• Affords and advocates for options and services to meet the client’s needs.
• Affords and advocates for options and services to meet the client’s needs.
• Assesses physicians' needs and develops action plans that proactively mitigate delays in therapy.
• Collaborates and maintains consistent communications with internal and external partners.
• Coordinates the exchange of all patient-related information with internal and external customers.
• Effectively manages database including data on each individual, their insurance, coverage approvals, on-going coverage requirements and all patient and provider interactions.
• Keeps up to date with reimbursement process, billing/coding nuances, insurance plans, payer trends, financial assistance programs, charitable access, related resources, regional level and alternative resources.
• Affords and advocates for options and services to meet the client’s needs.
• Affords and advocates for options and services to meet the client’s needs.
• Assists in obtaining insurance approvals/denials and/or appeals for therapy.
• Affords and advocates for options and services to meet the client’s needs.
• Affords and advocates for options and services to meet the client’s needs.
• Affords and advocates for options and services to meet the client’s needs.
• Affords and advocates for options and services to meet the client’s needs.
• Affords and advocates for options and services to meet the client’s needs.
• Affords and advocates for options and services to meet the client’s needs.
• Affords and advocates for options and services to meet the client’s needs.
• Affords and advocates for options and services to meet the client’s needs.
• Affords and advocates for options and services to meet the client’s needs.
• Affords and advocates for options and services to meet the client’s needs.
• Affords and advocates for options and services to meet the client’s needs.
• Affords and advocates for options and services to meet the client’s needs.
• Affords and advocates for options and services to meet the client’s needs.
• Affords and advocates for options and services to meet the client’s needs.
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• Affords and advocates for options and services to meet the client’s needs.
• Affords and advocates for options and services to meet the client’s needs.
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