Executive Care Coordinator

We need to output HTML fragment with sections: About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. Only include sections that have real specific content. We must not repeat job title as heading. Must not include Job ID etc. Remove boilerplate. Must preserve all substantive info. We need to parse the job posting. First part: description about Valeris (company overview). That could be "About the role"? Actually "About the role" is typical heading for role description. The company overview could be part of "About the role" or maybe we can include a short paragraph about the company under "About the role". The instruction: Use

for section headings (e.g. About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule). So we can have those headings if content exists. We need to extract: - About the role: description of what the role entails, maybe the introductory paragraph: "When you join the team as an Executive Case Manager, you'll have the opportunity to make a difference...". Also earlier company overview maybe part of about the role? Could include both. - Responsibilities: list of duties. The posting has a "Key Responsibilities" section with subheadings Relationship Management, Inbound Call Management, Personalized Case Management, etc. We need to list them as

• . Should we preserve subheadings? Probably just list each bullet as a responsibility. Could group under subheadings but not required. We'll output a list. - Requirements: maybe the "Physical Demands & Work Environment"? Or "Qualifications"? Actually Qualifications is separate. Requirements could be things like "Completion of Bachelor's degree (or higher) required..." etc. But they have a "Qualifications" section. The instruction includes both Requirements and Qualifications as possible headings. We need to decide what goes where. Typically Requirements are mandatory qualifications; Qualifications could be preferred. But we can map: Requirements: the mandatory items (degree required, experience). Qualifications: preferred certifications, bilingual, etc. However the posting lumps them together. We'll need to split based on wording. Let's extract: Qualifications section text: "Qualifications Completion of Bachelor's degree (or higher) required. Degree in healthcare administration, social science or similar related fields is strongly preferred. In lieu of a degree, five plus years of experience in insurance reimbursement, patient access, direct patient care, and/or patient education is required.Two years of experience in insurance reimbursement, patient access, direct patient care, and/or patient education is required.Minimum two years of experience in healthcare access delivery or management is strongly preferred.Will consider other certifications and five or more consecutive years of experience in relevant field. Certification examples include PACS (Prior Authorization Certified Specialist), CHES (Certified Health Education Specialist) or CCM in healthcare or social science (Certified Case Manager).Strong understanding of medical terminology, coding systems (ICD-10, CPT, HCPCS), and insurance processes.Demonstrated examples of executing within guardrails recognizing urgency and consistently delivering patient centric results.Excellent attention to detail and organizational skills.Ability to prioritize tasks and work efficiently in a fast-paced environment.Effective written and verbal communication and interpersonal skills, with the ability to interact professionally with diverse stakeholders.Demonstrates the ability to think critically and issue resolution.Knowledge of healthcare compliance regulations, including HIPAA and Medicare/Medicaid guidelines.Bi-lingual skills are a plus.Remote work eligibility is subject to all work from home criteria met and based on business need" That's a big block. We could separate into Requirements (mandatory) and Qualifications (preferred). Mandatory: Completion of Bachelor's degree (or higher) required. In lieu of a degree, five plus years of experience in insurance reimbursement, patient access, direct patient care, and/or patient education is required. Two years of experience in insurance reimbursement, patient access, direct patient care, and/or patient education is required. (maybe duplicate). Also Strong understanding of medical terminology, coding systems, insurance processes. Demonstrated examples of executing within guardrails... Excellent attention to detail... Ability to prioritize... Effective written and verbal communication... Demonstrates ability to think critically... Knowledge of healthcare compliance regulations including HIPAA and Medicare/Medicaid guidelines. Bi-lingual skills are a plus (maybe preferred). Remote work eligibility subject to criteria. Preferred: Degree in healthcare administration, social science or similar related fields is strongly preferred. Minimum two years of experience in healthcare access delivery or management is strongly preferred. Will consider other certifications and five or more consecutive years of experience in relevant field. Certification examples include PACS, CHES, CCM. Bi-lingual skills are a plus (already). Remote work eligibility. But we need to avoid duplication. We'll just put all under Qualifications maybe, and skip Requirements if content thin. However instruction: Prefer a few substantive sections over many thin ones. So we could combine Requirements and Qualifications into one section called "Qualifications". But they gave both as possible headings; we can choose to only include Qualifications if we have content, and omit Requirements if not enough distinct content. However we have substantive content for both; but we can merge. Similarly Skills: we could extract skills from qualifications: excellent communication, attention to detail, organizational, prioritization, critical thinking, etc. Could be a separate Skills section. Benefits: The "Why Work for Valeris?" section lists benefits: medical, dental, vision plans, HSA/FSA, telehealth, EAP, company match on HSA contributions, free basic life and AD&D, company-paid short-term disability, option to purchase long-term disability, 401(k) with 100% match on first 5%, PTO and sick leave, nine paid holidays plus two floating holidays, opportunities for advancement, challenging work environment, values diversity, mission-driven culture. Also maybe "Free Basic Life and AD&D coverage equal to your annual earnings, with a minimum of $50,000 and a maximum of $300,000". So we can create Benefits section. Pay: Not mentioned. So we should NOT include Pay section. Schedule: Not mentioned (no mention of full-time/part-time, hours). So omit Schedule. Thus sections: About the role, Responsibilities, Qualifications (maybe also Skills), Benefits. We could also include Skills separate: communication, attention to detail, etc. But we already have many in Qualifications; maybe better to keep Qualifications only. Let's craft About the role: combine company overview and role description. Company overview: "Valeris is a fully integrated life sciences commercialization partner that provides comprehensive solutions that span the entire healthcare value chain. Formed by the merger of PharmaCord and Mercalis, Valeris™ revolutionizes the path from life sciences innovation to real-life impact to build a world in which every patient gets the care they need. Valeris works on behalf of life sciences companies to improve the patient experience so that patients can access and adhere to critical medications. Backed by proven industry expertise, a deep commitment to patient care, the latest technology, and exceptionally talented team members, Valeris provides the data and strategic insights, patient support services and healthcare provider engagement tools to help life sciences companies successfully commercialize new products. Valeris provides commercialization solutions to more than 500 life sciences customers and has provided access and affordability support to millions of patients. The company is headquartered in Morrisville, North Carolina and Jeffersonville, Indiana." Then role description: "When you join the team as an Executive Case Manager, you'll have the opportunity to make a difference in the lives of our patients each day as they look to you as part of their dedicated support team for helping them navigate the tricky process of getting access to their complex medication. You'll compassionately deliver an exceptional experience to many patients per day, always remembering that every prescription or document belongs to a real person who is looking for thorough and efficient management of their records. You'll adjust your approach to their needs by communicating clearly, focusing on the accuracy of the details of their medical records, your mastery of the program requirements, and ensuring their prescriptions or cases are handled in a timely manner. An Executive Case Manager has the ability to translate knowledge into patient friendly language and education. A typical day in this role will include ownership of your patient journey from initiation to closure by using your critical thinking skills and your knowledge of the program and industry rules and standards. This includes completing benefit investigations, tracking prior authorizations / denial appeals, and assisting patients or other callers/stakeholders through resolution (via email, inbound/outbound calls and using our patented technology, Lynk). This role requires a strong understanding of pharmacy and medical billing and coding, excellent communication skills, and the ability to navigate complex reimbursement processes. The Executive Case Manager provides expertise on insurance coverage and common access and reimbursement challenges affecting patients, healthcare providers and clients." We can combine. Now Responsibilities: list bullet points from the "Key Responsibilities" section. Let's extract each bullet: Relationship Management: - Builds trusted relationships with patients, prescribers, and appropriate client stakeholders regarding reimbursement inquiries and challenges 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 all relevant laws, regulations, program-specific operating procedures and industry standards related to access and affordability, including HIPAA and insurance guidelines. - Managed through call/contact center structure, this role supports inbound and outbound calls to patients, caregivers, specialty pharmacies and healthcare professionals. - Performs post Benefits Investigation calls to patients and/or physicians explaining coverage options and next steps in the access journey. - Manages all client inquiries as appropriate, such as case specific statuses. - Manages HCP inquiries, as applicable, pursuant to business rules. - All communications with the client’s field teams will remain compliant and adhere to ways of working protocols outlined between Valeris and the client teams. 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, specialty pharmacies and patients to communicate benefit coverage and/or appropriately help drive next steps in obtaining coverage and/or access to prescribed medicine. All communications for case management will follow the guidelines set forth for the program and only provide information publicly available and/or outlined in the patient insert. - 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. - Serves as a subject matter expert to internal team as required and appropriate. - 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 nurse educators, as applicable to program. - Supports adherence services as applicable to program. - Identifies peer support resources for patients. - Proactively communicates needs for reverification of prior authorization or re-enrollment. - Identifies and reports adverse events, product complaints, special situation reports and/or medical inquiries received in accordance with program operating procedures and the Business Rules. - Documents all activities within the Lynk system, maintaining detailed records of reimbursement activities, including claims status, payments, and appeals. - Generate reports and analysis as needed to identify trends and opportunities for improvement. - 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 We need to ensure we don't include boilerplate like "in accordance with business requirements." maybe it's part of bullet. We'll keep. Now Qualifications: we need to list maybe as bullet points as well. But we can also use

  for prose. The instruction: Use

  • for any list of duties/requirements/benefits, and

    for prose. So for qualifications we could use list if it's a list. It's a list of requirements. We'll use

    • .