Case Manager

Job Description

Job Description

Position Objective : The Case Manager handles drug or treatment specific prescription processing, investigates drug or treatment specific coverage and benefits to assist the MDOs (medical doctors’ 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’ access to treatment. The Case Manager provides customer service, operations support and is able to adapt to the changing needs of the Company’s manufacturer contracts and applicable hub services programs.

Accountability : The incumbent will report to the Program Manager.

Essential Functions :

• Handles benefits request investigations submitted by MDOs (medical doctors’ offices).
• Contacts insurance companies directly to obtain information on a patient’s medical benefits, specialty pharmacy benefits and / or prescription benefits.
• Contacts MDO to obtain, relay and / or verify information on patient's demographics.
• Obtains each case's medical benefits for the procedure / diagnosis codes for the requested or prescribed medication.
• Assists in facilitating the completion of authorizations for, or in combination with the MDO.
• Connects via phone with the MDO regarding clinicals, authorizations, transfers and / or follow-ups.
• Serves as a primary contact for inbound calls, answers inquiries regarding submitted cases, follow-ups and other case related issues, assisting the MDOs.
• Communicates with field access managers and key account managers on a regular basis for updates, support and to help ensure program needs are being met. Communicates with and assists sales representatives, as needed.
• Accesses and relays pertinent information on patients’ medical benefits to MDO and staff.
• Assists MDO with reimbursement inquiries or takes note of contact information for a return call with the appropriate answer.
• Documents and makes notations in the system regarding the case information.
• Uses discretion and independent judgment in handling customer complaints received, while documenting and forwarding to appropriate administrative staff.
• Handles and troubleshoots challenging cases for resolution and completion.
• Communicates 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’s care or physician’s needs.
• Performs other duties as assigned by the Program Manager or the Team Lead.
• 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.

Knowledge, Skills & Abilities :

Work Environment / Physical Activity :

Working Conditions : Normal office and home office environment

Culture Environment : Team-oriented, positive attitude

Equipment Used : Telephone, computer, fax, copier

Position :

Work Hours : Monday through Friday, 9 : 30 AM - 6 : 00 PM, 10 : 30 AM - 7 : 00 PM, or 11 : 30 AM - 8 : 00 PM (half-hour lunch break and (2) fifteen-minute breaks)

Benefit Eligible : Full-time only

STATEMENT

Critical features of this job are described herein. They are intended to describe the general nature of the position and the level of work required, and are not meant to be an exhaustive list of all responsibilities, duties and skills required. They may be subject to change due to reasonable accommodation or other reasons. Nothing in this job description restricts the company’s right to assign or reassign duties and responsibilities to this job at any time.

ACKNOWLEDGEMENT

I have read this job description and fully understand the requirements set forth therein. I acknowledge that I have been afforded an opportunity to ask questions. I hereby accept this and agree to perform the identified essential functions in a safe manner and in accordance with the company’s established procedures.

This job description does not constitute a contract for employment.