Executive Case Manager

When you join the team as an Executive 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 of 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, your mastery of the program requirements, and ensuring their prescriptions or cases are handled in a timely manner. An Executive Case Manager has the ability to translate knowledge into patient friendly language and education.

A typical day in this role will include ownership of your patient journey from initiation to closure by using your critical thinking skills and your knowledge of the program and industry rules and standards. This includes completing benefit investigations, tracking prior authorizations / denial appeals, and assisting patients or other callers/stakeholders through resolution (via email, inbound/outbound calls and using our patented technology, Lynk). This role requires a strong understanding of pharmacy and medical billing and coding, excellent communication skills, and the ability to navigate complex reimbursement processes.

The Executive Case Manager provides expertise on insurance coverage and common access and reimbursement challenges affecting patients, healthcare providers and clients. The Executive Case Manager responsibilities include education on the access and reimbursement support tools available from PharmaCord and participating program, advising HCPs and/or patients and caregivers on the benefits and program eligibility for a specific patient, and educating HCP offices on Payor processes and procedures.

A typical day in the life of an Executive Case Manager will include the following:

The responsibilities include, but are not limited to the following:

• Relationship Management
• Builds trusted relationships with patients, prescribers, and appropriate client stakeholders regarding reimbursement inquiries and challenges 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 all relevant laws, regulations, program-specific operating procedures and industry standards related to access and affordability, including HIPAA and insurance guidelines.
• Managed through call/contact center structure, this role supports inbound and outbound calls to patients, caregivers, specialty pharmacies and healthcare professionals.
• Performs post Benefits Investigation calls to patients and/or physicians explaining coverage options and next steps in the access journey.
• Manages all client inquiries as appropriate, such as case specific statuses.
• Manages HCP inquiries, as applicable, pursuant to business rules.
• All communications with the client’s field teams will remain compliant and adhere to ways of working protocols outlined between PharmaCord and the client teams. 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, specialty pharmacies and patients to communicate benefit coverage and/or appropriately help drive next steps in obtaining coverage and/or access to prescribed medicine. All communications for case management will follow the guidelines set forth for the program and only provide information publicly available and/or outlined in the patient insert.
• 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.
• Serves as a subject matter expert to internal team as required and appropriate.
• 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 nurse educators, as applicable to program.
• Supports adherence services as applicable to program.
• Identifies peer support resources for patients.
• Proactively communicates needs for reverification of prior authorization or re-enrollment.
• Identifies and reports adverse events, product complaints, special situation reports and/or medical inquiries received in accordance with program operating procedures and the Business Rules.
• Documents all activities within the PharmaCord Lynk system, maintaining detailed records of reimbursement activities, including claims status, payments, and appeals.
• Generate reports and analysis as needed to identify trends and opportunities for improvement.in accordance with business requirements.
  

Requirements:

• Completion of Bachelor's degree (or higher) required
• A degree in healthcare administration, social science or similar related fields is strongly preferred.
• Minimum two years of experience in healthcare access delivery or management is strongly preferred.
• 5-10 years of experience in insurance reimbursement, patient access, direct patient care, and/or patient education experience will be considered in lieu of degree.
• Will consider other certifications and five or more consecutive years of experience in relevant field. Certification examples include PACS (Prior Authorization Certified Specialist), CHES (Certified Health Education Specialist) or CCM in healthcare or social science (Certified Case Manager).
• Strong understanding of medical terminology, coding systems (ICD-10, CPT, HCPCS), and insurance processes.
• Demonstrated examples of executing within guardrails recognizing urgency and consistently delivering patient centric results.
• Excellent attention to detail and organizational skills.
• Ability to prioritize tasks and work efficiently in a fast-paced environment.
• Effective written and verbal communication and interpersonal skills, with the ability to interact professionally with diverse stakeholders.
• Demonstrates the ability to think critically and issue resolution.
• Knowledge of healthcare compliance regulations, including HIPAA and Medicare/Medicaid guidelines.
• Bi-lingual skills are a plus.
• We are located in Jeffersonville, IN. PharmaCord does reimburse for tolls if applicable, at the frequent user rate. This rate is applied after 40 trips per month (valued at $678.60 per year).
• Remote work eligibility is subject to all work from home criteria met and based on business need
  
  

Physical Demands & Work Environment:

• This is an office-based position, the ability to sit for extended periods of time is necessary.
• While performing the duties of this job, the employee is regularly required to talk or hear. The employee is frequently required to sit for long periods of time, use hands to type, handle or feel; and reach with hands and arms. Must be able to type 35 WPM with 97% accuracy.
• Although very minimal, flexibility to travel as needed is preferred.
• This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, etc.
• This position requires ability to work a standard 8.5-hour standard shifts between our business operating hours of 8am - 11pm Monday through Friday. A shift will be assigned and may change depending on business need.
• Due to investment in program specific training, candidates are expected to maintain role for a minimum of 6 months, or within a client-facing role, prior to being considered eligible for lateral or promotion level move. PharmaCord is committed to creating a strong company culture that values collaboration, employee development, and promotion from within. Exceptions will be reviewed on a case-by-case basis to assess business need and service impact.
  
  
  

Once you land this position, you’ll get to enjoy:

Our Benefits & Perks

• Company paid Short-term Disability (STD)
• Increased competitive 401(k) company match up to 4%
• Affordable Medical, Dental, and Vision benefits - PharmaCord covers 75% of Medical Premiums for our employees
• PharmaCord has not increased healthcare premiums in the past 4 years
• Concierge Medical Clinic free of cost for those enrolled in a PharmaCord medical plan (including dependents)
• Wellness discounts of up to $260 per year for participation in wellness program
• Annual HSA employer contribution
• Company paid and voluntary Life Insurance options
• Voluntary Life, AD&D and Long-Term Disability Insurances
• Paid Parental Leave of Absence
• Wellness and Employee Assistance Programs
• PTO benefits, flex days and paid holidays
• Employee Referral Program
• Ambassador Program
• Tuition reimbursement program up to $5,000 per year
  
  

Competitive Compensation & Flexible Working

• Competitive starting pay rates
• Yearly merit increases
• Toll reimbursement program (valued at $655.20 per year)
• This role may be remote eligible. To qualify to work remotely, you must show you've successfully completed training, are in good performance and attendance standing, and are consistently meeting KPI's as outlined within the program business rules.
• Multiple shift options between 8 AM and 11 PM Monday - Friday
  
  
  

A Career You'll Love

• Working for PharmaCord - voted Best Places to Work in Kentucky for 2019 and 2021
• Work for a company that values diversity and makes deliberate efforts to create in inclusive workplace
• Opportunities for advancement with a company that supports personal and professional growth
• A challenging, stimulating work environment that encourages new ideas
• Exposure to many learning and development opportunities
• Playing a crucial part in the lives of our patients, physicians, and pharmacies by enhancing the patient services experience
• Our new state of the art Headquarters building offering many amenities including collaborations spaces, outdoor dining, walking path, marketplace café, and more!
  
  
  

Any offer of employment is contingent on completion of a background check to company standard. Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

At PharmaCord, we don’t just accept difference – we celebrate it, support it and we thrive on it for the benefit of our employees, our products and our community. PharmaCord is proud to be an equal opportunity employer.

In order to maintain a safe workplace for our team members, PharmaCord strongly recommends that all employees are vaccinated against COVID-19.

PharmaCord is unable to sponsor employees at this time.

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