Case Manager / Patient Advocate (non-clinical)

About the role

A typical day in the Case Manager / Patient Advocate (non-clinical) 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.

Key Responsibilities

• 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
• Communications - Performs program welcome calls to patients, performs post Benefits Investigation calls to patients and physicians explaining coverage options
• 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
• 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

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

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
Opportunities for advancement in a company that supports personal and professional growth
A challenging, stimulating work environment that encourages new ideas
A mission-driven, inclusive culture where your work makes a meaningful impact