Case Manager Job
Job Description Job Attributes+
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Job ID
a2a582b7-8a77-48d2-a649-89cf11169daf
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Req #
20164051
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Job Location
Remote Location
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Job Category
Clinical Operations
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Job Type
Regular
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Schedule
Full time
Cardinal Health Sonexus™ Access and Patient Support helps specialty pharmaceutical manufacturers remove barriers to care so that patients can access, afford and remain on the therapy they need for a better quality of life. Our diverse expertise in pharma, payer and hub services allows us to deliver best-in-class solutions—driving brand and patient markers of success. We’re continuously integrating advanced and emerging technologies to streamline patient onboarding, qualification and adherence. Our non-commercial specialty pharmacy is centralized at our custom-designed facility outside of Dallas, Texas, empowering manufacturers to rethink the reach and impact of their products.
Together, we can get life-changing therapies to patients who need them—faster.
Responsibilities
• Monitor system accounts for new Patient cases
• Conduct outbound calls to patients to confirm approval/denials of coverage, co-pays and verification of specialty pharmacy that will dispensing their medication
• Contact insurance companies as required to obtain and enter accurate benefit information to positively impact insurance processing and minimize rejections
• Mediate effective resolution for complex payer/pharmacy issues toward a positive outcome to de-escalate
• Place outbound calls to patients to assess for eligibility for co-pay and financial assistance
• Answer minimal inbound calls from doctors and/or patients checking on status of case
• Maintain quality while providing an empathetic and supportive experience to the patients, providers, and physician offices
• Resolve patient's questions and concerns regarding status of their request for assistance
• Enter detailed information into company proprietary software while conversing via telephone
• Steward patient accounts from initial contact through final approval/denial
• Process all patient applications in accordance to set policy, procedures and PHI compliance
• Speak with manufacturer field team members on case updates via phone or by email
• Works internally with team members regarding patients’ cases
• Ability to identify, document and submit Adverse Events during customer contact or via received documentation
• Conduct research associated with alternative funding or foundations to ensure patient has required information to receive product
Qualifications
• Minimum of HS diploma; additional education preferred
• Previous healthcare experience with insurance or in pharmaceutical industry, preferred
• Pharmacy benefits management experience preferred with specific knowledge of Medicare, Medicaid and commercially insured payer common practices and policies, preferred
• Previous prior authorization and appeals experience highly desired
• Knowledge of ICD coding, preferred
• Intermediate Microsoft skills with specific experience with Excel
• Organized with the ability to prioritize multiple, concurrent assignments and work with a sense of urgency
• Exceptional communication skills both verbally and written
• Self-starter with demonstrated initiative, creativity and a willingness to learn
• Must be willing to work 10a-7p CST
What is expected of you and others at this level
• Effectively applies knowledge of job and company policies and procedures to complete a variety of assignments
• In-depth knowledge in technical or specialty area
• Applies advanced skills to resolve complex problems independently
• May modify process to resolve situations
• Works independently within established procedures; may receive general guidance on new assignments
