Case Manager
Summit Access Solutions,LLC
Full-time
On-site
Coraopolis, Pennsylvania, United States
Registered Nurse
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 Ma nager 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 p rimary 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 journe y .
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 us e 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
S upporting 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
Work Environment
RareMed offers a hybrid work structure, combining remote work and in-office requirements. The frequency of onsite requirements will vary depending on role, operational needs, meetings, client visits, or team collaboration activities. Employees must be within commuting distance to Pittsburgh, PA, and able to report to the office when needed. We will provide advance notice when possible. This role routinely involves standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines. When telecommuting, employees must have reliable internet access to utilize required systems and software required for the position's responsibilities. The amount of time the employee is expected to work per day or pay period will not change while working from home. Employees are responsible for the set-up of their home office environment, including physical set-up, internet connection, phone line, electricity, lighting, comfortable temperature, furniture, etc. Employee’s teleworking space should be separate and distinct from their “home space” and allow for privacy.
Physical Demands While performing the duties of this job, the employee is regularly required to talk or hear. The employee frequently is required to stand; walk; use hands and fingers, handle or feel; and reach with hands and arms.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function of the job.
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 Ma nager 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 p rimary 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 journe y .
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 us e 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
S upporting 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
Work Environment
RareMed offers a hybrid work structure, combining remote work and in-office requirements. The frequency of onsite requirements will vary depending on role, operational needs, meetings, client visits, or team collaboration activities. Employees must be within commuting distance to Pittsburgh, PA, and able to report to the office when needed. We will provide advance notice when possible. This role routinely involves standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines. When telecommuting, employees must have reliable internet access to utilize required systems and software required for the position's responsibilities. The amount of time the employee is expected to work per day or pay period will not change while working from home. Employees are responsible for the set-up of their home office environment, including physical set-up, internet connection, phone line, electricity, lighting, comfortable temperature, furniture, etc. Employee’s teleworking space should be separate and distinct from their “home space” and allow for privacy.
Physical Demands While performing the duties of this job, the employee is regularly required to talk or hear. The employee frequently is required to stand; walk; use hands and fingers, handle or feel; and reach with hands and arms.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function of the job.