Oncology Case Manager

About the role

This position is Full-Time, remote working Monday - Friday. We offer quarterly incentive bonuses with plenty of growth opportunities!

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 of free goods programs where applicable as per program business rules
• Support the facilitation of 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 as per the program-approved Frequently Asked Questions (FAQs), Call Guides, Call Scripts, and other program-approved material
• Field inbound calls from prescribers, patients and client’s account teams as directed by the program approved FAQs
• Inform and support patients by providing education and information throughout their therapy journey as to the status of their medication, needed processes, and connection to other stakeholders providing support like their Oncology treatment care team or pharmacy
• Create trusting relationships with physician offices and client department teams in their 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 as necessary
• Demonstrate an understanding of business rules, work instructions, and company-approved communications for patients and HCPs
• Navigate operating platform with ease. Document and meticulously make notations in each patient’s profile regarding every update and aspect of patient’s journey
• Use discretion and independent judgment in handling customer complaints received, while 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
• Must exhibit excellent skills in the following areas: verbal/written communication, computer/data entry/software proficiency, interpersonal and relationship-building skills, self-discipline, attention to detail, and the ability to maintain strict confidentiality

Qualifications

• Education/Learning Experience: 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, preferred. 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: Minimum of 5 years of pharmacy experience. Desired: Minimum of 2 Years of patient support program experience
• Strong verbal and written communication skills with the ability to adapt communication style and word choice to effectively convey information to various audience types, inclusive of patients, healthcare providers and cross-functional teams
• Proactive mindset where potential challenges are anticipated and initiative is taken towards effective solutions to support patients, providers, and care team members through access issues to ensure timely resolution and to prevent delays in treatment initiation
• Working knowledge and experience with health insurance (pharmacy benefit), Medicare Part D coverage, prior authorization processes, and medication reimbursement specifically for specialty drugs
• Understanding of US health care policies and relevant legal, compliance, regulatory requirements
• Understanding of HIPAA and privacy laws and requirements and maintains patient confidentiality
• Experience with Adverse Event and Product Quality Complaint reporting
• Limited travel may be required for trips to company meetings, key customer meetings, or other association meetings as determined by leadership
• Licenses/Certifications: N/A. Desired: Pharmacy Technician, PACS (Prior Authorization Certified Specialist), CHES (Certified Health Education Specialist) or CCM in healthcare or social science (Certified Case Manager)