Patient Case Manager

Job Description

Job Description

Purpose :

The Patient Case Manager is a professional patient facing role responsible for various functions, including proactive outreach and support as well as accurate and timely response to patient inquiries regarding specific referral status or escalation. The Patient Case Manager serves as a primary point of contact for professional, concise internal and external communication regarding case status updates, next steps in prescription processing, communication of reimbursement issues, etc. The Patient Case Managers will interact directly with patients communicating updates on internal activities and will be required to collaborate with internal reimbursement and clinical teams to support the patient journey. The Patient case manager will also be a single point of contact to doctors' offices as it relates to Prior Authorization actions and status updates related to referrals.

Responsibilities :

Primary point of contact and case manager for patient support, inquiries and escalations. Coordinates services with internal program operations and Program Management

Conducting initial welcome call to patients informing them of available services as we well as future targeted outreach to provide ongoing

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

Use high-level problem-solving skills to research cases independently, using professional judgement to make sound decisions

Maintain frequent phone contact with internal operational staff in order to resolve any inquires or requests from the patient and HCP offices

Provides exceptional, white glove, customer service to internal and external customers; resolves any customer, client, or physician requests in a timely and accurate manner; escalates appropriately

Provides support to ensure efficient referral processing from referral intake to triaging of prescription

Independently and effectively resolves complex issues with creativity and innovation

Application of defined business rules to qualify patients for manufacturer supported programs

Ability to coordinate and collaborate with manufacturer representatives, HCP offices and other key personnel on complex cases which require strategic intervention

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.

Ability to understand payer trends, product access, and reporting reimbursement trends and / or delays (i.e. denials, underpayment, access delays, etc.)

Required Qualifications :

College degree (bachelors or associate degree) or relevant prior work experience

Previous 2+ years of experience in a pharmacy, healthcare setting, and / or insurance background; customer service focus

Advanced knowledge and experience in healthcare setting

Ability to communicate effectively both orally and in writing with a focus on customer satisfaction

Ability to independently manage case load, prioritize work, and us time management skills to manage deliverables

Empathy, drive and commitment to exceptional service

Strong analytical and organizational skills with attention to detail

Ability to work flex schedule per Program business needs

Possess effective oral and written communication skills

Possess a strong understanding of biologic / specialty pharma market and patient access challenges

Ability to leverage professional expertise and apply company policies and procedures to resolve challenges

Preferred Qualifications :

Ability to build productive internal / external working relationships

Experience with benefit investigation and benefit verification of prescription benefits

Strong interpersonal skills

Ability to proficiently use Microsoft Excel, Outlook and Word

Certified Pharmacy Technician or Case Management Experience

Working Knowledge of Third-Party and other Foundation programs

Basic understanding of Co-Pay Assistance (if applicable)

Work Environment

This job operates in a professional office environment and teleworking from the employee’s home address listed in their employment file. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines. When telecommuting employees must have reliable internet access in order to access required systems and software associated with the position's responsibilities. The amount of time the employee is expected to work per day or pay period will not change as a result of participation in the teleworking program. Employees are responsible for the set-up of their home office environment, including physical set-up, internet connection, phone line, electricity, good lighting, comfortable temperature, furniture, etc. Employee’s teleworking space should be separate and distinct from their “home space” and allow for privacy. RareMed expects employees teleworking to be as efficient and professional as if they were in the office. The amount of time spent in office or teleworking is contingent upon the needs / priorities of RareMed and will vary based on those needs / priorities.

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.