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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