Regional Patient Case Manager-Long Term Care

Purpose:

The Regional Patient Case Manager – Long Term Care (RPCM-LTC) is a professional client facing role responsible for various functions, including accurate and timely response to client inquiries regarding patient-specific programs, referral status or escalation, benefits verification and financial assistance counseling. The RPCM-LTC acts as a single point of contact for communication and coordination among all participants of the LTC facility health care team to ensure that the services are provided. The RPCM-LTC is responsible for providing professional, concise internal and external communication regarding case status updates, next steps in prescription processing, shipment set ups, and communication of reimbursement issues. The RPCM-LTC oversees the provision of extended, ongoing services to residents of long-term care facilities. Also, provides intensive case management in a collaborative process that includes therapy initiation, referrals to Specialty Distributors, and triages to Specialty Pharmacy or Long-Term Care Pharmacies.

Responsibilities:

• Serve as the point of contact for regionally aligned field team related to cases identified as LTC to initiate and support therapy to residents of long-term care facilities.
• Coordinate all LTC facility-related support and access services across all functions but not limited to: support on patient journey calls, benefits verification, prior authorization and appeals, triage to specialty pharmacy or Long-Term Care Pharmacies, and any necessary follow ups.
• Maintain clear, concise, and accurate documentation on all accounts according to Standard Operating Procedures.
• Review and add LTC profile data to capture the key information related to LTC facilities and customers.
• Conduct initial welcome calls to LTC facility-designated champions and/or patients/caregivers informing them of available services as well as future targeted outreach to provide ongoing support.
• Maintain frequent touchpoints through outreach to LTC providers and patients/caregivers to communicate progress throughout their journey.

• Work independently to complete assigned work in accordance with Standard Operating Procedures and defined service levels to complete program enrollment, answer inquiries, and coordinate access to free 14-Day Supply Program, if applicable.

• Independently and effectively identify adverse events and/or product complaints to document and triage as appropriate.

• Apply defined business rules to qualify patients for manufacturer supported programs.
• Interact and coordinate with internal program operations, including reimbursement, and program management to ensure provider and patient needs are met in addition to attending any regularly scheduled calls.
• Provide support, education and status updates to regionally aligned field teams, LTC facility staff, patients and caregivers to ensure efficient referral processing, triaging, and shipment set ups.
• Manage assigned territory using problem solving skills and professional judgement to independently make sound decisions for timely case resolution.
• Ability to coordinate and collaborate with manufacturer representatives, LTC facilities and other key personnel on complex cases which require strategic intervention.
• Independently and effectively resolves complex issues with creativity and innovation while maintaining compliance.
• Refer patients to third-party or other foundation programs per program business rules.
• Manage case triage to Specialty Pharmacy or Long Term Care Pharmacy, if applicable, and ensure proper information has been communicated to the Specialty Pharmacy Liaison.
• Collaborate with Long Term Care Pharmacies and field teams on account progression and case recovery efforts and provide relevant case status details and updates.
• Process PAP requests, when applicable per program business rules, in a timely fashion and PAP re-approval verification for continued eligibility.
• Demonstrate the ability to prioritize and balance the needs of patients, LTC facility staff and rare disease clients utilizing program business rules.
• Provide concierge-level service to internal and external customers; resolve any customer and client requests in a timely and accurate manner; escalate appropriately.
• Maintain frequent phone/email contact with internal operational staff, external client, external specialty pharmacies, providers and payers. Utilizes outbound faxes, email alerts, and mailings per program guidelines.
• Strong compliance mindset, demonstrating clear understanding of patient privacy laws.
• Actively participate in building and maintaining respectful, collaborative team relationships, exercising, and encouraging positivity.
• Other duties as assigned including cross training to support all Regional Patient Case Manager activities when needed.
• This position may require flexibility in scheduling, with shifts occurring between 8:00AM and 8:00PM EST, Monday through Friday. Employees should be prepared to work within this timeframe as needed.
• Other duties as assigned.

Required Qualifications:

• High school diploma plus 2 years recent case management experience
• Previous 3 years of experience in a pharmacy, healthcare setting, and/or insurance background preferably in long term care reimbursement or disability care
• Advanced knowledge and experience in healthcare setting
• Strong interpersonal skills; ability to communicate effectively both orally and in writing with a focus on customer satisfaction
• Empathy, drive and commitment to exceptional service
• Ability to build productive internal/external working relationships
• Ability to independently manage case load, prioritize work, and use time management skills to meet deliverables

Preferred Qualifications:

• Undergraduate degree and/or equivalent work experience
• Certified Pharmacy Technician (CPhT) or Case Management Experience
• Long-term care reimbursement/case management experience is a major plus
• Bilingual Spanish speaking and writing is plus
• Strong analytical and organizational skills with meticulous attention to detail
• Experience with benefit investigation and verification of prescription benefits
• Working knowledge of Third-Party and other Foundation programs a major plus
• Understanding of plan types – Government, Commercial, Medicaid, VA, Fed
• Knowledge of insurance structure (ex PBM's, major medical plans, co-pay assistance /cards)
• Ability to proficiently use Microsoft Teams, Excel, Outlook and Word

Work Environment

RareMed offers a hybrid work structure, combining remote work and in-office requirements. The frequency of onsite requirements will vary depending on role, operational needs, meetings, client visits, or team collaboration activities. Employees must be within commuting distance to Pittsburgh, PA, and able to report to the office when needed. We will provide advance notice when possible. This role routinely involves standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines. When telecommuting, employees must have reliable internet access to utilize required systems and software required for the position's responsibilities. The amount of time the employee is expected to work per day or pay period will not change while working from home. Employees are responsible for the set-up of their home office environment, including physical set-up, internet connection, phone line, electricity, lighting, comfortable temperature, furniture, etc. Employee's teleworking space should be separate and distinct from their "home space" and allow for privacy.

Physical Demands

While performing the duties of this job, the employee is regularly required to talk or hear. The employee frequently is required to stand; walk; use hands and fingers, handle or feel; and reach with hands and arms.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function of the job.