What are the responsibilities and job description for the Case Manager position at Valeris?
We are actively seeking candidates for the 11:30 AM - 8 PM ET shift.
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. This role may be eligible for a hybrid schedule after 6 months (or sooner once proficiency in role is demonstrated).
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, Lynk) 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!
Your Responsibilities
The responsibilities include, but are not limited to the following:
- Relationship Management
- Builds trusted relationships with patients, prescribers, client stakeholders through proactive communication, timely and accurate execution of deliverables and demonstrated relentless passion for helping patients
- Manages all relationships in a manner that adheres to healthcare laws and regulations
- Communications
- Performs program welcome calls to patients
- Performs post Benefits Investigation calls to patients and physicians explaining coverage options
- Manages all client inquiries unable to be determined by client through reporting
- Manages HCP inquiries, as applicable, pursuant to business rules
- Inbound Call Management
- Manages inbound calls as directed by the program-approved FAQs
- Triage patients to internal or external resources as appropriate
- Personalized Case Management
- 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
- Leverages electronic tools to identify benefits and payer coverage; completes manual benefit investigation as needed
- Identifies and communicates patient’s plan benefit coverage including the need for prior authorization, appeal, tier exception, and/or formulary exclusions
- 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
- Coordinates nurse teach with field-based nurse educators, as applicable to program
- Supports adherence services through coordination of nurse follow up, as applicable to program
- Identifies peer support resources for patients
- Coordinates shipment of product through patient assistance program and/or bridge program from the PharmaCord pharmacy
- Proactively communicates needs for reverification of prior authorization or re-enrollment for patient assistance program
- Reports adverse events, Product complaints, special situation reports and/or medical inquiries received in accordance with SOPs and the Business Rules
- Documents all activities within the Valeris Lynk system in accordance with business requirements
You have the following qualifications
- Bachelor’s degree strongly preferred
- Customer service and healthcare industry experience is preferred but not required
- Ability to work an 8.5-hour shift between 8 am to 9 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