Case Manager

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    "requisitionDescription": "<div><p data-pasted=\"true\"><u>Position Objective</u>: The Case Manager handles drug or treatment specific prescription processing, investigates drug or treatment specific coverage and benefits to assist the MDOs (medical doctors&rsquo; offices), as well as assists in facilitating the completion of authorizations for, or in combination with MDOs, along with handling other program related work, in order to facilitate patients&rsquo; access to treatment. The Case Manager provides customer service, operations support and is able to adapt to the changing needs of the Company&rsquo;s manufacturer contracts and applicable hub services programs.</p><p><br></p><p><u>Accountability</u>: The incumbent will report to the Program Manager.</p><p>&nbsp;&nbsp;</p><p><u>Essential Functions</u>:</p><ul type=\"disc\"><li><div style=\"margin-left:0in;\" data-pasted=\"true\"><p>Manages assigned cases from end to end (from receipt of referral to triage); Included but not limited to benefit result communication, prior authorization assistance and triage to the partnered SP (Specialty Pharmacy).</p></div></li><li><div style=\"margin-left:0in;\" data-pasted=\"true\"><p>Transfers the prescription to the partnered specialty pharmacy based on triage rules.</p></div></li><li><div style=\"margin-left:0in;\" data-pasted=\"true\"><p>Contact insurance companies directly to obtain information on a patient&rsquo;s specialty pharmacy benefits and/or prescription benefits in coordination with the Reimbursement Specialist.</p></div></li><li><div style=\"margin-left:0in;\" data-pasted=\"true\"><p>Contacts MDO to obtain, relay and/or verify information on patient&#39;s demographics.</p></div></li><li><div style=\"margin-left:0in;\" data-pasted=\"true\"><p>Relays pharmacy benefit coverage results for prescribed medication.</p></div></li><li><div style=\"margin-left:0in;\" data-pasted=\"true\"><p>Assists in facilitating the completion of authorizations for, or in combination with the MDO, and assists in filing an appeal if necessary.</p></div></li><li><div style=\"margin-left:0in;\" data-pasted=\"true\"><p>Connects via phone with the MDO regarding clinicals, authorizations, transfers and/or follow-ups.</p></div></li><li><div style=\"margin-left:0in;\" data-pasted=\"true\"><p>Regularly communicate with partnered manufacturer Patient Navigators to ensure alignment on patient journey or product training needs.</p></div></li><li><div style=\"margin-left:0in;\" data-pasted=\"true\"><p>Serves as primary contact for inbound calls, case notes and live chat. answers Answers inquiries regarding submitted cases, follow-ups and other case related issues, assisting the MDOs.</p></div></li><li><div style=\"margin-left:0in;\" data-pasted=\"true\"><p>Provides information regarding funding options available to patients with financial hardships.</p></div></li><li><div style=\"margin-left:0in;\" data-pasted=\"true\"><p>Assesses and relays pertinent information on patients&rsquo; pharmacy benefits to MDO and staff.</p></div></li><li><div style=\"margin-left:0in;\" data-pasted=\"true\"><p>Assists MDO with reimbursement inquiries, gathering contact information for a return call with the appropriate answer.</p></div></li><li><div style=\"margin-left:0in;\" data-pasted=\"true\"><p>Documents and make notations in the system regarding case information.</p></div></li><li><div style=\"margin-left:0in;\" data-pasted=\"true\"><p>Use discretion and independent judgment in handling customer complaints received, while documenting and forwarding to appropriate administrative staff.</p></div></li><li><div style=\"margin-left:0in;\" data-pasted=\"true\"><p>Handles and troubleshoots challenging cases for resolution and completion.</p></div></li><li><div style=\"margin-left:0in;\" data-pasted=\"true\"><p>Communicate with the Program Manager, Team Lead and other program specific team members, regarding any information received from the physician, insurance company or employees about the customer&rsquo;s care or physician&rsquo;s needs.</p></div></li><li><div style=\"margin-left:0in;\" data-pasted=\"true\"><p>Performs other duties as assigned by the Program Manager or the Team Lead.</p></div></li><li><div style=\"margin-left:0in;\" data-pasted=\"true\"><p>Must exhibit excellent skills in the following areas: verbal/written communication, computer/data entry/software proficiency, interpersonal and relationship-building skills, self-discipline, pro-activeness, attention to detail, and the ability to maintain strict confidentiality.</p><p><br></p><p><br></p></div></li></ul><p style=\"line-height: 1.5;\"><u>Knowledge, Skills &amp; Abilities</u>:</p><ul type=\"disc\"><li><p>Associate&rsquo;s degree or equivalent from a two-year college, technical school or certificate program in pharmacy and/or healthcare, preferred. High School Diploma or GED, required.</p></li><li><p>1-3 years&rsquo; years&#39; experience in the medical/healthcare or insurance field (i.e. hub services, pharmacy, doctor&#39;s office, hospital administration, health plan member services, etc.), required.</p></li><li><p>Experience in pharmacy benefit investigation, retail pharmacy or specialty pharmacy adjudication strongly preferred.</p></li><li><p>Superior level of customer service, interpersonal skills, and highly effective in working objectively with a diverse group of people.</p></li><li><p>Excellent verbal/written communication skills, self-discipline, and attention to detail.</p></li><li><p>Proficient in data entry, computer skills, and able to learn the department&rsquo;s software system.</p></li><li><p>Must be a team player willing to accept organizational and team goals, and function with minimal supervision.</p></li><li><p>Maintain HIPAA patient confidentiality, as well as discretion regarding proprietary company information.</p></li><li><p>Adaptable, able to shift gears and focus based on company and team needs.</p></li></ul></div>\n",
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