Oncology Case Manager

This position is full-time, remote, with an initial schedule of Monday - Friday, 9:30am to 6:00pm EST, eventually transitioning to 11:30am to 8:00pm EST. Starting salary is $60k and up, depending on experience. We offer quarterly incentive bonuses and plenty of growth opportunities.

About the role

ConnectMed360 creates customized patient support programs that connect manufacturers, providers, and patients to simplify the patient journey and deliver specialty medications and coordinated care quickly. As an Oncology Case Manager, you will play a key role in ensuring patients gain access to oral oncology medications by working directly with patients, prescribers, insurance providers, and care team members to facilitate the payer coverage process and drive holistic patient support.

Responsibilities

• Perform benefit verification and coverage determination to identify and communicate the patient’s plan benefit coverage, including the need for prior authorization, appeal, tier exception, and/or formulary exclusions.
• Support the facilitation of prior authorization and appeal processes by gathering necessary clinical documentation and information, with guidance from senior team members as needed.
• Screen, enroll, and educate eligible patients in free goods programs where applicable as per program business rules.
• Perform patient outreach as needed to facilitate prescription fulfillment and therapy adherence as per program rules.
• Comprehensively understand the benefits investigation process, insurance plans, and available patient assistance programs.
• Operate both inbound and outbound calls using program-approved FAQs, call guides, scripts, and other materials.
• Field inbound calls from prescribers, patients, and client’s account teams as directed by program-approved FAQs.
• Inform and support patients by providing education and information throughout their therapy journey regarding medication status, needed processes, and connections to other stakeholders like their oncology treatment care team or pharmacy.
• Assist in monitoring and maintaining the reauthorization of insurance coverage process to ensure continuity of therapy access.
• Serve as the primary point of contact for incoming phone calls from patients, caregivers, physicians, and client’s department teams. Proactively provide updates to internal and external stakeholders on patient cases in a timely manner.
• Create trusting relationships with physician offices and client department teams in assigned region(s).
• Conduct scripted welcome calls and ongoing educational support calls to patients and office staff to introduce the program and confirm required enrollment information.
• Demonstrate an understanding of business rules, work instructions, and company-approved communications for patients and healthcare providers (HCPs).
• Navigate operating platforms with ease and document meticulous notations in each patient’s profile regarding every update and aspect of the patient’s journey.
• Use discretion and independent judgment in handling customer complaints, documenting and forwarding to appropriate team members.
• Communicate with Directors, Team Leads, Supervisor, and Program Manager on noteworthy program updates or obstacles.
• Communicate with specialty pharmacies to obtain patient case updates and ensure the prescription process is moving forward. Coordinate with Non-Commercial Pharmacy and schedule shipments as needed.
• Report Adverse Events/Product Complaints in accordance with SOP and good manufacturer practices.
• Perform other duties as assigned by management.

Requirements

• Minimum of 5 years of pharmacy experience.
• Strong verbal and written communication skills with the ability to adapt communication style to effectively convey information to various audience types, including patients, healthcare providers, and cross-functional teams.
• Proactive mindset to anticipate potential challenges and take initiative toward effective solutions to support patients, providers, and care team members through access issues.
• Working knowledge and experience with health insurance (pharmacy benefit), Medicare Part D coverage, prior authorization processes, and medication reimbursement specifically for specialty drugs.
• Working knowledge of US healthcare policies and relevant legal, compliance, and regulatory requirements.
• Understands HIPAA and privacy laws and maintains patient confidentiality.
• Experience with Adverse Event and Product Quality Complaint reporting.
• Limited travel may be required for company meetings, key customer meetings, or other association meetings as determined by leadership.

Qualifications

• Education/Learning Experience Required: High School Diploma or equivalent.
• Desired: Bachelor’s or associate degree, or equivalent program from a two-year college or technical school, or certificate program in pharmacy and/or healthcare field. Certification preferences include PACS (Prior Authorization Certified Specialist), CHES (Certified Health Education Specialist), CCM in healthcare or social science (Certified Case Manager), or Social Worker Field Work.
• Experience Desired: Minimum of 2 years of patient support program experience.
• Licenses/Certifications Desired: Pharmacy Technician, PACS (Prior Authorization Certified Specialist), CHES (Certified Health Education Specialist), or CCM in healthcare or social science (Certified Case Manager).

Skills

• Excellent verbal and written communication.
• Computer/data entry/software proficiency.
• Interpersonal and relationship-building skills.
• Self-discipline and attention to detail.
• Ability to maintain strict confidentiality.

Benefits

• Medical, dental, and vision coverage.
• 401k with a company match.
• Paid time off and paid holidays.
• Tuition reimbursement.
• Company-paid benefits: life insurance and short- and long-term disability.