Case Manager / Patient Advocate (non-clinical)

About the role

The Case Manager / Patient Advocate (non-clinical) role at Valeris involves managing patients' cases from initiation to closure, including benefit investigations, prior authorizations/denial appeals, determining financial qualifications for assistance programs, and assisting patients or other callers/stakeholders through resolution.

Responsibilities

• Builds trusted relationships with patients, prescribers, and client stakeholders through proactive communication, timely and accurate execution of deliverables, and demonstrating a relentless passion for helping patients.
• Manages all relationships in compliance with healthcare laws and regulations.
• Performs program welcome calls to patients.
• Performs post-Benefit Investigation calls to patients and physicians, explaining coverage options.
• Manages all client inquiries that cannot be determined by the client through reporting.
• Manages HCP inquiries, as applicable, according to business rules.
• Inbound Call Management: Manages inbound calls as directed by approved FAQs, triaging patients to internal or external resources as necessary.
• 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.
• Coordinates nurse teach with field-based nurse educators, as applicable to the program.
• Supports adherence services through coordination of nurse follow-up, as applicable to the program.
• Identifies peer support resources for patients and 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 business rules.
• Documents all activities within the PharmaCord Lynk system in accordance with business requirements.
• Utilizes Valeris’ values as the driving force behind the team’s success.
• Ensures adherence to training deadlines for all corporate policies and procedures.
• Ensures all SOPs are followed with consistency.
• Performs additional tasks or projects as assigned.

Qualifications

• Successful candidates possess the following personal attributes: detail oriented, professional telephone etiquette, self-awareness of emotions, ability to multitask, ability to recognize emotions, sureness about self-worth and capabilities, manage disruptive impulses, maintain standards of honesty and integrity, take responsibility for performance, adapt and handle change with flexibility, be innovative and open to new ideas, achievement driven, constant striving to improve or 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 in English and Spanish or Chinese/Mandarin is a plus.

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. 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.