Case Manager

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.

We deliver our services through our talented team of benefit specialists, nurses, pharmacists, case managers, pharmacy techs, program managers, and other incredibly talented team members who are supported by world-class proprietary technology systems developed in house by our team of engineers, system architects, coding professionals and data scientists.

We are PharmaCord, a purpose-driven organization on a rapid growth journey.

Our Team: Our team is highly motivated and passionate about providing the highest quality customer support to our patients. We look for individuals interested in growing with our company and working in an exciting, open and collegial work environment. We seek problem solvers who are compassionate, have high integrity and demonstrate grit. Our colleagues are enthusiastic team members who love what they do and are passionate about making a difference through their work. We take initiative, exhibit pride in our accomplishments, and are trusted to work independently while collaborating to share ideas, support, and resources.

When you join the team as the 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 to 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 and your mastery of the program requirements, and ensuring their prescriptions or cases are handled timely.

A typical day in this role will include ownership of your patients cases from initiation to closure to include; benefit investigations, prior authorizations / denial appeals, determining financial qualifications for assistance programs and assisting patients or other callers/stakeholders through resolution (via email, inbound/outbound calls and using our patented technology, CORscend) by using your critical thinking skills and your knowledge of the program and industry rules and standards. This role requires a high level of ownership, attention to detail and patient focus and will put your problem-solving skills to the test!

A typical day in the life of a Case Manager will include the following:

The responsibilities include, but are not limited to the following:

·        Relationship Management

o  Builds trusted relationships with patients, prescribers, client stakeholders through proactive communication, timely and accurate execution of deliverables and demonstrated relentless passion for helping patients

o  Manages all relationships in a manner that adheres to healthcare laws and regulations

·        Communications

o  Performs program welcome calls to patients

o  Performs post Benefits Investigation calls to patients and physicians explaining coverage options

o  Manages all client inquiries unable to be determined by client through reporting

o  Manages HCP inquiries, as applicable, pursuant to business rules

·        Inbound Call Management

o  Manages inbound calls as directed by the program-approved FAQs

o  Triage patients to internal or external resources as appropriate

·        Personalized Case Management

o  Provides personalized case management to patients and HCPs including outbound communication to HCPs and patients to communicate benefit coverage and next steps in obtaining coverage

o  Leverages electronic tools to identify benefits and payer coverage; completes manual benefit investigation as needed

o  Identifies and communicates patient’s plan benefit coverage including the need for prior authorization, appeal, tier exception, and/or formulary exclusions

o  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

o  Coordinates nurse teach with field-based nurse educators, as applicable to program

o  Supports adherence services through coordination of nurse follow up, as applicable to program

o  Identifies peer support resources for patients

o  Coordinates shipment of product through patient assistance program and/or bridge program from the PharmaCord pharmacy

o  Proactively communicates needs for reverification of prior authorization or re-enrollment for patient assistance program

o  Reports adverse events, Product complaints, special situation reports and/or medical inquiries received in accordance with SOPs and the Business Rules

o  Documents all activities within the PharmaCord CORscend system in accordance with business requirements

This job might be for you if (must have requirements of the role):

Successful candidates possess the following personal attributes:

·        Detail oriented

·        Professional telephone etiquette

·        Self-awareness of your own emotions and the potential impact on others

·        Basic computer knowledge

·        Ability to multitask effectively

·        Ability to recognize emotions and their effects

·        Sureness about self-worth and capabilities

·        Manage disruptive impulses

·        Maintain standards of honesty and integrity

·        Takes responsibility for performance

·        Adapts and handles change with flexibility

·        Is innovative and open to new ideas

·        Achievement driven; constant striving to improve or to meet a standard of excellence

·        Aligns with the goals of the group or organization

·        Ready to take initiative and act on opportunities

·        Be optimistic and pursue goals persistently despite obstacles and setbacks

·        Be service oriented and anticipate, recognize and meet needs of others, including patients and care partners

·        Clear and concise communication

Education and Experience:

·        Bachelor’s degree in arts and sciences, social work, public health administration or a related field

·        3 years’ customer service, payer benefits (reimbursement, prior authorization, etc.), healthcare industry experience is preferred

·        Ability to work any 8.5-hour shift between 8 am to 8 pm, Monday to Friday required

·        Bi-lingual in English and Spanish or Chinese/Mandarin is a plus

·        This is an office-based position, the ability to sit for extended periods of time is necessary

·        Although very minimal, flexibility to travel as needed is preferred

Physical Demands:

·        Ability to sit for extended periods of time

·        Ability to travel as needed

·        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.

Work Schedule & Environment

·        This is a full-time or part-time position (depending on business need). Standard shifts fall between our business hours of 8am to 8pm and will depend on business need. 

·        This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, etc.

·        Due to investment in program specific training, candidates are expected to maintain role for a minimum of 6 months to 1 year, especially within a client-facing role, prior to being considered eligible for lateral or promotion level move. PharmaCord is committed to creating a strong company culture that values collaboration, employee development, and promotion from within. Exceptions will be reviewed on a case-by-case basis to assess business need and service impact.

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

·        A compassionate patient services-oriented environment

·        Benefits of a dynamic and growing organization

·        A challenging, hands on role that will have real impact on the business

·        Competitive hourly compensation

·        Comprehensive benefits package

Any offer of employment is contingent on completion of a background check and drug screen 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.

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