Executive Case Manager (Remote)

About the role

The Executive Case Manager role at Valeris is a remote position available to candidates residing in the state of Ohio. This role involves managing patient journeys from initiation to closure, providing personalized case management, and handling various aspects of patient access and reimbursement.

Responsibilities

• Builds trusted relationships with patients, prescribers, and stakeholders regarding reimbursement inquiries and challenges through proactive communication, timely and accurate execution of deliverables, and demonstrating a relentless passion for helping patients.
• Manages all relationships in compliance with relevant laws, regulations, program-specific operating procedures, and industry standards related to access and affordability, including HIPAA and insurance guidelines.
• Performs post-Benefit Investigation calls to patients and/or physicians to explain 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.
• Communicates with client’s field teams in a way that remains compliant and adheres to ways of working protocols outlined between PharmaCord and the client teams.
• Manages inbound calls as directed by the program-approved FAQs.
• Triage patients to internal or external resources as appropriate.
• 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.
• 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.
• Leverages 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 re-verifications 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 PharmaCord Lynk system, maintaining detailed records of reimbursement activities, including claims status, payments, and appeals.
• Generates reports and analysis as needed to identify trends and opportunities for improvement in accordance with business requirements.
• Utilizes Valeris’ values as the driving force behind the team’s success.
• On time 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

• Completion of Bachelor's degree (or higher) required.
• A 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.
• Five or more consecutive years of experience in relevant field, or will consider other certifications like PACS, CHES, or CCM in healthcare or social science.
• 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.

Benefits

Valeris offers a comprehensive benefits package including:

• 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.
• 401(k) Retirement Savings Plan with 100% match on the first 5% you contribute, with immediate vesting.
• Short-Term Disability coverage, with the option to purchase Long-Term Disability.
• Paid Time Off (PTO) and Sick Leave to support work-life balance.
• Nine paid holidays plus two floating holidays.
• 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.

Pay

Compensation is commensurate with experience.

Schedule

This is a remote role.