Executive Case Manager (Remote)

Direct message the job poster from PharmaCord

Talent Acquisition Specialist @ PharmaCord | Healthcare Recruitment, Candidate Experience

Our Company: PharmaCord is a leading provider in pharmaceutical patient support services. Our services are sponsored by our pharmaceutical company clients. Together, we are committed to compassionately providing patients with support services during their journey on therapy.

When you join the team as an Executive Case Manager, you'll have the opportunity to make a difference in the lives of our patients each day as they look to you as part of their dedicated support team for helping them navigate the tricky process of getting access to their complex medication. You'll compassionately deliver an exceptional experience to many patients per day, always remembering that every prescription or document belongs to a real person who is looking for thorough and efficient management of their records. You'll adjust your approach to their needs by communicating clearly, focusing on the accuracy of the details of their medical records, your mastery of the program requirements, and ensuring their prescriptions or cases are handled in a timely manner.

This role will include ownership of your patient journey from initiation to closure by using your critical thinking skills and your knowledge of the program and industry rules and standards. This includes completing benefit investigations, tracking prior authorizations/denial appeals, and assisting patients or other callers/stakeholders through resolution (via email, inbound/outbound calls and using our patented technology, Lynk). This role requires a strong understanding of pharmacy and medical billing and coding, excellent communication skills, and the ability to navigate complex reimbursement processes.

The Executive Case Manager provides expertise on insurance coverage and common access and reimbursement challenges affecting patients, healthcare providers and clients. The Executive Case Manager responsibilities include education on the access and reimbursement support tools available from PharmaCord and participating program, advising HCPs and/or patients and caregivers on the benefits and program eligibility for a specific patient, and educating HCP offices on Payor processes and procedures.

A typical day in the life of an Executive Case Manager will include but not be limited to the following:

• Relationship Management
• Builds trusted relationships with patients, prescribers, and appropriate client stakeholders regarding reimbursement inquiries and challenges through proactive communication, timely and accurate execution of deliverables and demonstrated relentless passion for helping patients.
• Manages all relationships in a manner that adheres to all relevant laws, regulations, program-specific operating procedures and industry standards related to access and affordability, including HIPAA and insurance guidelines.
• Managed through call/contact center structure, this role supports inbound and outbound calls to patients, caregivers, specialty pharmacies and healthcare professionals.
• Performs post Benefits Investigation calls to patients and/or physicians explaining coverage options and next steps in the access journey.
• Manages all client inquiries and as appropriate, such as case specific statuses.
• Manages HCP inquiries, as applicable, pursuant to business rules.
• All communications with the client’s field teams will remain compliant and adhere to ways of working protocols outlined between PharmaCord and the client teams. Inbound Call Management
• Manages inbound calls as directed by the program-approved FAQs.
• Triage patients to internal or external resources as appropriate.
• Personalized Case Management
• Provides personalized case management to patients and HCPs including outbound communication to HCPs, specialty pharmacies and patients to communicate benefit coverage and/or appropriately help drive next steps in obtaining coverage and/or access to prescribed medicine. All communications for case management will follow the guidelines set forth for the program and only provide information publicly available and/or outlined in the patient insert.
• Leverages electronic tools to identify benefits and payer coverage; completes manual benefit investigation as needed.
• Identifies and communicates patient’s plan benefit coverage including the need for prior authorization, appeal, tier exception, and/or formulary exclusions.
• Serves as a subject matter expert to internal team as required and appropriate.
• Uses electronic resources to obtain benefit coverage outcome and if needed, outbound call to payers and HCPs to follow up on proper submission and/or outcome.
• Coordinates nurse teach with nurse educators, as applicable to program
• Supports adherence services as applicable to program.
• Identifies peer support resources for patients.
• Proactively communicates needs for reverification of prior authorization or re-enrollment.
• Identifies and reports adverse events, product complaints, special situation reports and/or medical inquiries received in accordance with program operating procedures and the Business Rules
• Documents all activities within the PharmaCord Lynk system, maintaining detailed records of reimbursement activities, including claims status, payments, and appeals.
• Generate reports and analysis as needed to identify trends and opportunities for improvement.in accordance with business requirements.

Requirements:

• Completion of Bachelor's degree (or higher) required. Degree in healthcare administration, social science or similar related fields is strongly preferred. In lieu of a degree, five plus years of experience in insurance reimbursement, patient access, direct patient care, and/or patient education is required.
• Two years of experience in insurance reimbursement, patient access, direct patient care, and/or patient education is required.
• Minimum two years of experience in healthcare access delivery or management is strongly preferred.
• Will consider other certifications and five or more consecutive years of experience in relevant field. Certification examples include PACS (Prior Authorization Certified Specialist), CHES (Certified Health Education Specialist) or CCM in healthcare or social science (Certified Case Manager).
• Strong understanding of medical terminology, coding systems (ICD-10, CPT, HCPCS), and insurance processes.
• Demonstrated examples of executing within guardrails recognizing urgency and consistently delivering patient centric results.
• Excellent attention to detail and organizational skills.
• Ability to prioritize tasks and work efficiently in a fast-paced environment.
• Effective written and verbal communication and interpersonal skills, with the ability to interact professionally with diverse stakeholders.
• Demonstrates the ability to think critically and issue resolution.
• Knowledge of healthcare compliance regulations, including HIPAA and Medicare/Medicaid guidelines.

Physical Demands & Work Environment:

• While performing the duties of this job, the employee is regularly required to talk or hear. The employee is frequently required to sit, use hands to type, handle or feel; and reach with hands and arms. Must be able to type 35 WPM with 97% accuracy.
• Ability to sit for extended periods of time.
• This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, etc.
• This position requires ability to work a standard 8.5-hour standard shifts between our business operating hours of 8am - 11pm Monday through Friday. A shift will be assigned and may change depending on business need.

Once you land this position, you’ll get to enjoy:

• Affordable Medical, Dental, and Vision benefits with no premium increases in 4 years
• 401(k) company match
• Wellness discounts on health premium
• HSA employer contribution
• Company paid Short-term Disability (STD)
• Company paid and voluntary Life Insurance options
• Voluntary Life, AD&D and Long-Term Disability Insurances
• Paid Parental Leave of Absence
• Wellness and Employee Assistance Programs
• PTO benefits, flex days and paid holidays
• Employee Referral Program

A Career You'll Love

• Working for PharmaCord - voted Best Places to Work in Kentucky for 2019 and 2021.
• Voted Best Companies for Employee Happiness, Best Companies for Women and Culture by Comparably in 2023.
• Work for a company that values diversity and makes deliberate efforts to create in inclusive workplace.
• Opportunities for advancement with a company that supports personal and professional growth.
• Playing a crucial part in the lives of our patients, physicians, and pharmacies by enhancing the patient services experience.

Any offer of employment is contingent on completion of a background check to company standard. Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

At PharmaCord, we don’t just accept difference – we celebrate it, support it and we thrive on it for the benefit of our employees, our products and our community. PharmaCord is proud to be an equal opportunity employer. PharmaCord is unable to sponsor employees at this time.