Case Manager

Role Overview

• Take the lead to manage the Care Coordination process within an assigned territory
• Use tact and independent judgment to balance patient and physician needs with the business realities and necessities of the program
• Establish and maintain professional and effective relationships with all internal and external customers (i.e., care coordination colleagues, care field team, patient advocacy groups, insurance company case managers, specialty pharmacies, physician office staff and office coordinators) while multitasking to coordinate, evaluate and advocate for options and services to meet the client’s needs
• Assess physicians’ needs and develop action plans that proactively mitigate delays in therapy
• Coordinate the exchange of all patient-related information with internal and external customers (i.e., patients, families, healthcare providers, insurance companies, and specialty pharmacies)
• Effectively manage database including data on each individual, their insurance, coverage approvals, on-going coverage requirements and all patient and provider interactions
• Keep up to date with reimbursement process, billing/coding nuances, insurance plans, payer trends, financial assistance programs, charitable access, related resources, regional level and alternative resources
• Assist in obtaining insurance approvals/denials and/or appeals for therapy
• Assist patients and HCP with processing applications for Copay Assistance/Reimbursement and Patient Assistance Programs
• Assist with ordering/triaging prescriptions for patient or HCP
• Provide education to patients and health care providers, regarding insurance requirements, options and limitations necessary to initiate therapy
• Provide education on relevant disease/product information
• Exhibit a leadership role by demonstrating accountability for action plan execution, and energetically drive for success and results
• Support special projects as requested.

Requirements

• Bachelor’s Degree (or equivalent) in related area with focus in Health Care, Social Work, Nursing, preferred
• Minimum of three (3) years of recent experience with health care insurance benefits, relevant state and federal laws, and insurance regulations
• Proven ability to assess the ethics and legality of patient care
• Recent experience in the case management process is preferred
• In-depth understanding of health care insurance benefits, relevant state and federal laws and insurance regulations, highly desired
• Experience with data entry/computer literate skills, preferred
• Strong verbal and written communication skills, including effectively communicating with clients/providers/patients and employees of ConnectiveRx in a professional and courteous manner
• Mediation, and problem-solving skills
• Ability to speak Spanish is a plus

Benefits

• medical, dental, vision, life, and disability insurance
• 401(k) plan with employer contributions
• flexible paid time off (PTO) policy
• eight standard company holidays and three floating holidays