Case Manager

Case Manager

Requirements

• Superior Interpersonal Skills Acumen: Ability to collaborate effectively with internal and external team members. Assist other team members when needed and offer support to ensure shared goals are met.
• Open Minded & Adaptable: Be open to new ideas, feedback, and change. Willingness to learn and adapt to evolving patient needs and organizational goals. Ability to step up and contribute outside of normal responsibilities when needed. Embrace new challenges and changes, demonstrating flexibility in working with various teams and handling diverse patient needs.
• Patient-Centric Approach: Demonstrate a strong focus on patient care, ensuring that patient needs are always prioritized and that you go the extra mile to ensure their satisfaction and success.
• Dedicated: A self-motivated and diligent approach to your work, ensuring tasks are completed accurately and efficiently while maintaining high-quality care for patients.
• Expert Communicator: Strong verbal and written communication skills, with the ability to clearly convey information to patients, healthcare providers and cross-functional teams. Ability to adapt communication style to the needs of the individual patient, ensuring clarity, empathy and understanding at all times.
• Proactive Problem Solver: Demonstrated ability to identify potential challenges before they arise and take initiative to find creative and effective solutions. Ability to anticipate patient, provider, and access issues, ensuring timely resolution to prevent delays in treatment initiation.
• Bachelor’s degree or equivalent experience required
• Minimum 2+ years of case management experience with at least 1 year in pharmaceutical or biotech case management (preferred); experience can be inclusive of case management within: Clinics, hospital based, insurance company
• Working knowledge and experience with health insurance, Medicare Part D coverage, prior authorization process, and Rx reimbursement, specifically in specialty drugs
• Understands HIPAA and privacy laws and requirements and maintains patient confidentiality
• Experience with Adverse Event and Product Quality Complaint reporting
• Up to 25% travel

Responsibilities

• Manage the patient journey, from initial prescription receipt through ongoing treatment support, ensuring timely and accurate services are provided.
• Partner with team members across departments to troubleshoot issues, share best practices, and ensure a holistic and patient-centric approach to care.
• Verify insurance coverage and prior authorization status, and help resolve any barriers to treatment; as well as collaboration with the Field Access Manager and Key Account Directors to monitor access challenges.
• Ensure that all aspects of the patient’s therapy initiation experience are well-coordinated, including the ability to support patient questions in accordance with prescribing information (PI) data as indicated.
• Provide continuous education based on the prescribing information (PI), monitor patient progress, and address any concerns to ensure adherence to the prescribed treatment plan.
• Utilize motivational interviewing communication techniques to deliver appropriate communication and engagement based on patient needs.

Preferred Qualifications

• Minimum 2+ years of case management experience with at least 1 year in pharmaceutical or biotech case management (preferred); experience can be inclusive of case management within: Clinics, hospital based, insurance company