Case Manager 11:30-8

Summit Access Solutions,LLC•Coraopolis, PA

2d•Hybrid

About The Position

The Case Manager (CM) is a phone-based, patient-facing role responsible for supporting patients and healthcare providers (HCPs) throughout the access and reimbursement process. The RPCM serves as the primary point of contact for both patients and HCP offices, ensuring proactive communication, accurate information exchange, and timely case resolution to support access to therapy. The CM conducts inbound and outbound calls to provide updates, resolve inquiries, and ensure first-call resolution whenever possible. They will work directly with HCPs to obtain missing information, guide them through the prior authorization (PA) and appeal processes, and confirm that payer-required documentation is submitted accurately and on time. In parallel, the RPCM provides proactive outreach and responsive support to patients, delivering clear communication on case status, next steps, and reimbursement outcomes. This role requires excellent communication and organization skills, a strong understanding of the payer and reimbursement landscape, and the ability to collaborate across multiple internal teams. The RPCM is regionally aligned to field teams and works closely with internal stakeholders, including Reimbursement, Clinical, Operations, Non-Commercial Pharmacy, and Program Management, to ensure a seamless and supportive patient experience.

Requirements

High school diploma plus 2+ years recent case management experience
Previous 2+ years in a pharmacy, healthcare setting, and/or insurance background
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

Nice To Haves

Undergraduate degree and/or equivalent work experience
Certified Pharmacy Technician (CPhT) or Case Management Experience
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, Medicare, Medicaid, VA, Federal
Knowledge of insurance structure (ex PBM’s, major medical plans, co-pay assistance /cards)
Ability to proficiently use Microsoft Teams, Excel, Outlook and Word

Responsibilities

Primary point of contact and case manager for client and customer needs, inquiries and escalations.
Serve as the primary point of contact for patients and HCP offices regarding case status, documentation needs, and next steps in the access process.
Handle inbound calls from patients and HCPs and ensure first-call resolution whenever possible.
Coordinate all patient and relevant HCP-related support and access services across all functions including but not limited to: support on status update calls, missing information, benefits verification, prior authorization and appeals, triage to specialty pharmacy, and any necessary follow ups.
Maintain clear, concise, and accurate documentation on all accounts according to Standard Operating Procedures.
Conduct initial welcome calls to patients informing them of available services as well as future targeted outreach to provide ongoing support.
Maintain frequent touchpoints through outreach to providers and patients 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 good programs.
Apply defined business rules to qualify patients for manufacturer supported programs.
Provide support, education, and status updates to field teams, HCP offices, and patients to ensure efficient referral processing, triaging, and shipment set ups.
Processes free good requests in a timely fashion and verifies appropriate program utilization and criteria.
PAP re-approval verification for continued eligibility.
Independently and effectively identify adverse events and product complaints.
Use problem solving skills and professional judgement to independently make sound decisions for timely case resolution.
Provide concierge-level service to internal and external customers; resolve any customer and client requests in a timely and accurate manner and escalate appropriately.
Ability to coordinate and collaborate with manufacturer representatives, HCP offices and other key personnel on complex cases which require strategic intervention. Independently and effectively resolves complex issues with creativity and innovation while maintaining compliance.
Maintain frequent phone/email contact with internal operational staff. Utilize outbound faxes, email alerts, and mailings per program guidelines.
Strong compliance mindset, demonstrating clear understanding of patient privacy laws.
Active participation in building and maintaining respectful, collaborative team relationships, exercising, and encouraging positivity.
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.