Virtual Case Manager
Description:
- Serve as a patient advocate on behalf of the patient to coordinate access to medicines for timely treatment initiation, training, and ongoing shipments across HCP office, payer, and specialty pharmacy.
- Understand a patient’s support needs and interaction preferences to deliver a seamless, tailored patient experience that helps each patient complete their treatment as prescribed by the HCP (Healthcare Professional).
- Provide support to patients and HCPs (Health Care Professional) throughout the prior authorization and appeals processes.
- Educate providers and patients on relevant payer policies to help ensure patients can start and stay on therapy.
- Provide support to each assigned patient about their coverage status while maintaining accurate information in the designated computer system to support data integrity of information relayed to customers and clients.
- Manage a regional caseload promptly as defined by Service Level Agreements.
- Triage accounts and patient cases to aligned Field Access Lead based on business rules established by client.
- Identify trends regarding reimbursement delays, patient concerns, and reports to leadership.
- Communicate with assigned patients, e.g., patient insurance benefit information, available out-of-pocket support, etc.
- Communicate with Field Access Lead regarding patient updates, missing information, and delivery of benefits.
- Collaborate with targeted providers and pharmacies by following up to ensure prescriptions are being processed.
- Help ensure patients have access to all information, by compliantly navigating payer reimbursement, and mitigating any patient out-of-pocket barriers, as applicable.
- Educate on and enroll patients in Patient Support Programs.
- Provide coverage by answering inbound calls from providers, clients, patients, care givers, and pharmacies when applicable.
- Follow all requirements associated with compliance with program regulations, including HIPAA (Health Insurance Portability and Accountability) and patient privacy.
Requirements:
- Bachelor’s degree required
- Minimum 1-2 years of industry experience with pharmaceutical or healthcare case management and knowledge of medical or pharmaceutical terminology.
- Experience with health insurance and Rx reimbursement.
- Understand HIPAA and privacy laws and requirements and maintain patient confidentiality
- Experience with Adverse Event and Product Quality Complaint reporting
- Maintain compliance with program business rules, standard operating procedures, and guidelines
- Outstanding case management is required
- Passionate about learning and able to share/communicate that passion to others
- Exhibit collaboration and follow up is necessary
- You must demonstrate the ability to work in a dynamic and culturally diverse workplace.
Benefits:
- Excellent Benefits – accrued time off, medical, dental, vision, 401k, disability & life insurance, paid maternity and bonding time benefits, employee discounts/promotions
- Generous performance-driven Incentive Compensation package
- Competitive environment with company wide recognition, contests, and coveted awards
- Exceptional company culture
- Recognized as a Top Workplace USA 2021
- Awarded a “Great Place to Work” award in 2022 and 2023 Fortune Best Workplaces in Biopharma 2022
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