Case Manager

Description:

EXECUTIVE CASE MANAGER ROLE RESPONSIBILITIES:

The Executive Case Manager provides expertise on insurance coverage and common access and reimbursement challenges affecting patients, healthcare providers and clients. The responsibilities include education on access and reimbursement support tools available from PharmaCord and the participating program, advising healthcare providers (HCPs) and/or patients and caregivers on the benefits and program eligibility for a specific patient, and educating HCP offices on payor processes and procedures.

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

– Managing 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 a contact center structure, this role supports outbound and inbound 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 specific case statuses

– Manages all HCP inquiries, as applicable, pursuant to business rules

– All communications with the clients field teams will remain compliant and adhere to ways of working protocols outlined between PharmaCord 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 and patients to communicate benefits coverage and next steps in obtaining coverage

– Leverages electronic tool to identify benefits and payer coverage; completes manual benefit investigations as needed

– Identifies and communicates patients plan benefit coverage including the need for prior auth, appeal, tier exception, and/or formulary exclusions

– Uses electronic resources to obtain benefit coverage outcome and if needed ,outbound call to payers and healthcare providers to follow up on proper submission/or outcome

A typical day in the life of a CASE MANAGER will include the following:

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

– Manages all relationships in a manner that adheres to healthcare laws and regulations

COMMUNICATIONS:

– Perform program welcome calls to patients

– Performs post benefits investigations calls to patients and physicians explaining coverage options

– Manages all client inquiries unable to be determined by client through reporting

– Manages HCP inquiries, as applicable, pursuant to business rules

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 benefits coverage and next steps in obtaining coverage

– Leverages electronic tool to identify benefits and payer coverage; completes manual benefit investigations as needed

– Identifies and communicates patients plan benefit coverage including the need for prior auth, appeal, tier exception, and/or formulary exclusions

– Uses electronic resources to obtain benefit coverage outcome and if needed ,outbound call to payers and healthcare providers to follow up on proper submission/or outcome

Additional Responsibilities:

– 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 efficient management of their records.

– Adjust your approach to their needs by communicating clearly, focusing on the accuracy of the details of their medical records and your mastery of the program requirements, and ensuring their prescriptions or cases are handled timely.

– Reporting of Adverse Events/Product Complaint inquiries received in accordance with SOP and good manufacturer practices

– Provides timely feedback to the company regarding service failures r customer concerns

– Effectively uses internal technology platform to complete claims processing and keep workflows moving

– Communicate with key medical practice accounts, sales representatives regarding the status of cases

– Provide consultative services where issues arise on how obstacles can be overcome to get patient on paid therapy.

Skills:

Customer service, Benefits administration, Prior Authorization, Benefit verification, Call center, Health insurance, Pharmacy, Insurance, Health care, Microsoft office

Top Skills Details:

Customer service,Benefits administration,Prior Authorization,Benefit verification,Call center,Health insurance,Pharmacy

Additional Skills & Qualifications:

Requirement for EXECUTIVE CASE MANAGER:

– Bachelors degree required (can substitute for 5 yrs of exp)

– 2 years of experience in insurance reimbursement, patient access, direct patient care and/or patient education required

Requirements for Case Manager:

– No degree requirement

– Healthcare experience required – unless candidate has bachelors degree & Strong customer service experience/tenure

– Medical terminology – strongly preferred

– 6 months of payer benefits experience (reimbursement, prior auth, etc), healthcare industry experience or healthcare related experience is required

– Bilingual is a plus (in Spanish or Chinese/Mandarin)

– Must have availability to train for the first 8 weeks on an 8:30am – 5:00pm schedule

– Ability to work on-site in Jeffersonville, IN at PharmaCord HQ (150 Hilton Dr.)

Additional Qualifications:

– Service minded individuals – focus on recognizing and meeting the needs of others (especially patients and care partners)

– Trouble-shooting and problem solving individuals

– Tough conversations – able to be a patient advocate for patients with high prescription costs

– Ability to handle personal health information with confidentiality

– Commitment to honesty and integrity

– Professionalism and a strong sense of proper business and customer service etiquette

– Clear verbal and written communication skills

– Accountability for results

– Ability to plan and prioritize tasks with close attention to detail

– Positive Attitude

Top Companies they like to see on a resume: RxCrossroads, Humana, Norton, Chewy,

All employees working on-site are strongly encouraged to be vaccinated, but not required

Experience Level:

Entry Level

About TEKsystems:

Were partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. Thats the power of true partnership. TEKsystems is an Allegis Group company.

The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.