Case Manager (Remote)

About This Role

The Case Manager is responsible for overseeing all aspects of patient enrollment, reimbursement, and service coordination for individuals prescribed specific medications. This role involves providing drug coverage support to physicians and patients, ensuring timely access to prescribed treatments, and offering continuous support through effective communication and available resources.

Responsibilities

• Responsible for the timely enrollment of the patient into the Patient Support Program
• Collaborate with the patient, insurer, and physician regarding the documentation necessary for maximal reimbursement coverage, including the investigation of all public and private insurers and supporting employer escalations as required
• Review the patient status and assist the prescribing physician to prepare documentation for public or private coverage by reviewing patient charts, assessing previous therapies and tests
• Provide therapy guidelines/education on the program to manage patient and physician expectations
• Collect information and conduct patient financial assessment eligibility based on program guidelines
• Ensure patient services are coordinated and tracked in a timely manner resulting in quick and continued access to therapy
• Report Adverse Events/Severe Adverse Events (AE/SAEs) following approved SOPs
• Maintain service levels in case management, including telephone answer rates, time to initiate contact with the patient, Adverse Events reported within twenty-four hours of receipt, and any other KPIs established as the Program level
• Electronically update the Customer Relationship Management (CRM) tool by providing timely patient and clinic information
• Foster and promote a spirit of teamwork while working with internal patient support teams
• Act as a liaison and provide ongoing feedback to the Program Manager based-on observations in the field and feedback from customers as it pertains to the quality of services, training, and other areas of importance
• Identify obstacles to obtaining coverage and channel this information to the Program Manager and/or Assistant Program Manager
• Complete all relevant reports (timesheets, expenses, mileage, validate CRM reports, etc.) as per specified timelines and as per required standards
• Flexibility to work within the operating hours of Monday - Friday, between 8:00am - 8:00pm (EST)
• Additional duties as requested by the Manager

Requirements

• Post secondary education with minimum of 2 years experience in health care
• Excellent verbal and written communication skills in English
• Strong analytical skills including interpretation of regulation and legislation
• Advanced knowledge of the pharmaceutical distribution industry