Position Summary:

Care Managers are responsible for contacting insurance companies to obtain correct eligibility information, perform benefit investigations, copay assistance and check prior authorization and/ or appeal status. This is a remote position with option to work in the Durham, NC office.

The information contained herein is intended to be an accurate reflection of the duties and responsibilities of the individuals assigned to this position. They are not intended to be an exhaustive list of the skills and abilities required to do the job. IQVIA reserves the right to revise the job or to require that other or different tasks be performed as assigned.

Primary Responsibilities:

• Responsible for answering in-bound calls and assisting customers with pharmacy related services.
• Obtain client information by answering telephone calls; interviewing clients; verifying information.
• Contact insurance companies for benefit investigation and coverage eligibility.
• Complete prior authorizations with attention to detail and accuracy, to then have the prepared prior authorization reviewed by a clinical pharmacist.
• Assist patients with the enrollment process for manufacturer and non-profit organization copay assistance programs.
• Provide customers with courteous, friendly, fast, and efficient service.
• Update job knowledge by participating in educational opportunities and training activities.
• Work efficiently both individually and within a team to accomplish required tasks.
• Maintain and improve quality results by adhering to standards and guidelines and recommending improved procedures.
• Any additional duties as assigned by program management.

Qualifications: Care Manager I

• High School diploma required, associate degree or higher preferred.
• Minimum 2 years’ experience in medical billing, insurance verification, or similar patient services experience preferred.

• Demonstrated time management skills; planning and prioritization skills; ability to multi-task and maintain prioritization of key projects and deadlines.
• Demonstrated effective presentation skills; ability to motivate others; excellent interpersonal (written and verbal) communication skills.
• Demonstrated effectiveness to work cross-functionally within a team.
• Demonstrated ability to work effectively in an independent environment.
• Demonstrated ability to build relationships with customers and third parties.
• Demonstrated ability to adapt to a fast-paced, changing work environment and responsibilities.
• Fully competent in MS Office (Word, Excel, PowerPoint)
• Excellent documentation accuracy
• Drive and enthusiasm for supporting customers.
• Excellent listening and problem-solving skills
• Experience using a CRM and integrated telephony platform a plus.
• Previous data entry experience and ability to type 30wpm
• Bilingual (Spanish) highly desirable
• Ability to use MS Office 

Qualifications: Care Manager II

• High School diploma required, associate degree or higher preferred.
• Minimum of 2 years’ experience in customer service in a call center or health care environment required (Examples: Hospital, insurance, health care or retail industries)
• 1 year ACSS or AbbVie Patient Services experience required.
• Experience using person-centered thinking/planning or motivational interviewing a plus.
• Ability to apply emotional intelligence and empathetic listening with all interactions.
• Demonstrated time management skills; planning and prioritization skills; ability to multi-task and maintain prioritization of key projects and deadlines.
• Demonstrated effective presentation skills; ability to motivate others; excellent interpersonal (written and verbal) communication skills.
• Demonstrated effectiveness to work cross-functionally within a team.
• Demonstrated ability to work effectively in an independent environment.
• Demonstrated ability to build relationships with customers and third parties.
• Demonstrated ability to adapt to a fast-paced, changing work environment and responsibilities.
• Fully competent in MS Office (Word, Excel, PowerPoint)
• Excellent documentation accuracy
• Drive and enthusiasm for supporting customers.
• Excellent listening and problem-solving skills
• Experience using a CRM and integrated telephony platform a plus.
• Capable to serve as ACSS SME
• Ability to participate in the development of programmatic materials including being consulted on new hire training.
• Ability to facilitate special administrative projects as assigned by Program Manager, coverage for Program Manager when Program Manager is out or leading conference call.
• Ability to serve as an “ACSS Delegate” during assigned functions both internal and external.

Professional Competencies:

• Business Skills and Knowledge
  • General Management: Demonstrate analytic and problem-solving skills and understand the impact of individual decisions on other parts of the organization and the environment.
  • Quality improvement: Application of techniques that continually improve the quality of care provided, patient safety, organizational performance, and the financial health of the organization.
• Knowledge of the Health Care Environment
  • Health Care Systems and Organization: Demonstrate an understanding of how the various components of the health care System is organized and financed, and how they interact to deliver medical and health care.
  • The Patient’s Perspective: Understand the patient experience, demonstrate a commitment to patients’ rights and responsibilities, and ensure that the organization provides a safe environment for patients and their families.
• Communication and Relationship Management
  • Relationship Management: The ability to build and maintain relationships with internal as well as external stakeholders that are anchored in trust and where decision-making is shared.
  • Communication Skills: Be able to utilize verbal, written and presentation skills to communicate an organization’s mission, vision, values and priorities to diverse audiences.
• Professionalism: The ability to align personal and organizational conduct with ethical and professional standards that include a responsibility to the patient and community, a service orientation, and a commitment to lifelong learning and improvement

IQVIA is a leading global provider of advanced analytics, technology solutions and clinical research services to the life sciences industry. We believe in pushing the boundaries of human science and data science to make the biggest impact possible – to help our customers create a healthier world. Learn more at https://jobs.iqvia.com

We are committed to providing equal employment opportunities for all, including veterans and candidates with disabilities. https://jobs.iqvia.com/eoe

IQVIA’s ability to operate and provide certain services to customers and partners necessitates IQVIA and its employees meet specific requirements regarding COVID-19 vaccination status. https://jobs.iqvia.com/covid-19-vaccine-status

The potential base pay range for this role is $22 per hour. The actual base pay offered may vary based on a number of factors including job-related qualifications such as knowledge, skills, education, and experience; location; and/or schedule (full or part-time). Dependent on the position offered, incentive plans, bonuses, and/or other forms of compensation may be offered, in addition to a range of health and welfare and/or other benefits.