Case Manager

Purpose: 

The Case Manager is a professional external facing role responsible for various functions, including proactive outreach and support as well as accurate and timely response to inquiries regarding specific referral status or escalation. The Case Manager must develop a deep understanding of program deliverables and will be responsible for ensuring program compliance to documented business rules. The Case Manager is responsible for the educational support and managing efficiently the service delivery of assigned program. The Case Manager serves as a primary point of contact for professional, concise internal and external communication regarding case status updates, next steps in prescription processing, communication of reimbursement support, etc.  The Case Manager will interact directly with patients, healthcare providers, and insurance payers as well as internal teams including Operations and Program Management to ensure cases are moving forward. The Case Manager will also collaborate and work closely with the field teams. The Case Manager will be communicating updates on internal activities and will be required to collaborate with internal, external, and clinical teams to support the patient journey. The role will require sound judgement and the highest level of professional standards in all interactions with not only our patients, but HCP offices, program and specialty pharmacies, payers and our client manufacturer. The Case Manager will be directly involved with the development and enhancement of program efficiencies and evaluating opportunities for improvement of the program experience for referred patients and HCP offices. 

Responsibilities: 

• Primary point of contact for patient journey.
• Coordinates services with internal program operations and Program Management.
• Ability to accurately assess, plan, implement, and evaluate patient/caller needs for guidance throughout patient journey.
• Possess a broad and deep understanding of assigned disease states, products, and support programs. 
• Work independently to complete assigned work in accordance with Standard Operating Procedures and defined service levels to complete program enrollment, answer inquiries, and coordinate access to therapies.
• Processing of patient and prescriber requests in order to ensure access to therapy in a timely manner.

• Utilizing strategic intervention, collaborate efficiently and with urgency with key personnel to expedite processing of referrals from initiation to delivery of product.
• Assist with challenges by demonstrating appropriate judgement skills to be able to make independent solid decisions.
• Assist in coordination of available reimbursement resources for our patients to ensure the efficient processing of referrals from initiation to delivery of prescribed product. 
• Maintain frequent phone contact to resolve any inquires or requests with internal operational staff, external teams and patients, and external specialty pharmacies.
• Provides exceptional, white glove, customer service to internal and external customers; resolves any customer and client requests in a timely and accurate manner; escalates appropriately.
• Provides support to ensure efficient referral processing and triaging of prescription.
• Ability to support payer processes, product access, and navigating prior authorization process in order to help patients gain access to product
• Ability to understand payer trends, product access, and reporting reimbursement trends and/or delays (i.e. denials, underpayment, access delays, etc.)
• Strong compliance mindset, demonstrating clear understanding of patient privacy laws.
• Active participation in building and maintaining respectful, collaborative internal/external team relationships, exercising and encouraging positivity. 
• Create program training materials, standard operation procedures, and quick reference guides for operational use.
• Collaborate with leadership to identify opportunities to improve program efficiency and patient care solutions.
• Remains flexible and responsive when changes occur in patient activity, workload and scheduling.
• Assumes accountability for own professional practice in achieving optimal patient outcomes.
• Use problem solving skills and professional judgement to independently make decisions. Other duties as assigned.

Required Qualifications: 

• Bachelor’s Degree or 3-5 years case management or patient advocacy experience
• Advanced knowledge and experience in healthcare setting, with 2+ years experience in a pharmacy, healthcare setting, and/or insurance background
• Strong analytical and organizational skills with attention to detail.

• Ability to independently manage case load, prioritize work, and use time management skills to manage deliverables
• Excellent verbal and written communication skills 
• Strong reimbursement knowledge of BI/BV prescription benefits; PA authorizations, access management
• Ability to proficiently use Microsoft Excel, Outlook and Word

Preferred Qualifications: 

• Pharmaceutical industry, reimbursement case management and /or specialty pharmacy experience a plus 
• Ability to build productive internal/external working relationships
• Case Management Experience
• Professional interpersonal skills with patients, HCP and manufacturer clients.
• Empathy, drive and commitment to exceptional service
• Ability to coordinate and manage deliverables with a sense of urgency.
• Meticulous attention to detail. 
• Ability to exercise independent judgment.
• Ability to demonstrate empathy, handles stressful patient situations with realistic expectations while
• Supporting a positive outlook
• Stays current in developments related to specific disease state.
• Ability to learn and navigate the CRM platform with ease
• Ability to learn new processes quickly