Case Manager

Responsibilities

• Primary point of contact for patient journey.
• Captures services with internal program operations and Program Management.
• Able to accurately assess, plan, implement, and evaluate patient/caller needs for guidance throughout patient journey.
• Possesses a broad and deep understanding of assigned disease states, products, and support programs.
• Works independently to complete assigned work in accordance with Standard Operating Procedures and defined service levels to complete program enrollment, answer inquiries, and coordinate access to therapies.
• Processes patient and prescriber requests in order to ensure access to therapy in a timely manner.
• Utilizes strategic intervention, collaborates efficiently and with urgency with key personnel to expedite processing of referrals from initiation to delivery of product.
• Assists with challenges by demonstrating appropriate judgement skills to be able to make independent solid decisions.
• Assists in coordination of available reimbursement resources for our patients to ensure the efficient processing of referrals from initiation to delivery of prescribed product.
• Maintains frequent phone contact to resolve any inquiries or requests with internal operational staff, external teams and patients, and external specialty pharmacies.
• Provides exceptional, white glove, customer service to internal and external customers; resolves any customer and client requests in a timely and accurate manner; escalates appropriately.
• Supports payer processes, product access, and navigating prior authorization process in order to help patients gain access to product.
• Understands payer trends, product access, and reporting reimbursement trends and/or delays (i.e., denials, underpayment, access delays, etc.).
• Strong compliance mindset, demonstrating clear understanding of patient privacy laws.
• Active participation in building and maintaining respectful, collaborative internal/external team relationships, exercising and encouraging positivity.
• Create program training materials, standard operation procedures, and quick reference guides for operational use.
• Collaborate with leadership to identify opportunities to improve program efficiency and patient care solutions.
• Remains flexible and responsive when changes occur in patient activity, workload and scheduling.
• Assumes accountability for own professional practice in achieving optimal patient outcomes.
• Uses problem solving skills and professional judgement to independently make decisions.

Required Qualifications

• Bachelor’s Degree or 3-5 years case management or patient advocacy experience.
• Advanced knowledge and experience in healthcare setting, with 2+ years experience in a pharmacy, healthcare setting, and/or insurance background.
• Strong analytical and organizational skills with attention to detail.
• Ability to independently manage case load, prioritize work, and use time management skills to manage deliverables.
• Excellent verbal and written communication skills.
• Strong reimbursement knowledge of BI/BV prescription benefits; PA authorizations, access management.
• Proficiently uses Microsoft Excel, Outlook and Word.

Preferred Qualifications

• Pharmaceutical industry, reimbursement case management and/or specialty pharmacy experience a plus.
• Case Management Experience.
• Professional interpersonal skills with patients, HCP and manufacturer clients.
• Empathy, drive and commitment to exceptional service.
• Ability to coordinate and manage deliverables with a sense of urgency.
• Meticulous attention to detail.
• Ability to exercise independent judgment.
• Ability to demonstrate empathy, handles stressful patient situations with realistic expectations while supporting a positive outlook.
• Stays current in developments related to specific disease state.
• Ability to learn and navigate the CRM platform with ease.
• Ability to learn new processes quickly.
• Ability to work in a hybrid work structure, combining remote work and in-office requirements.