Patient Nurse Navigator - Specialty Pharmacy

Optime Care • Berwyn, PA

4h • Hybrid

About The Position

We're seeking a Patient Navigator to join our dynamic team at Optime Care, where your expertise will directly contribute to improving health outcomes for patients with complex, chronic conditions and rare diseases. This role offers the opportunity to manage all aspects of care on the patient's behalf. The Patient Navigator collaborates with the patient and/or caregiver, the provider, the payer, and the Optime Care Team Members throughout the entire care continuum. The Patient Navigator’s primary function is to support patients and caregivers with access to receiving therapy and long-term follow-up.
This position may require up to 25% travel based on patient and client needs. The position is expected to be in our Berwyn office location when not traveling. This position is also eligible to become a hybrid role after an introductory period, depending on business needs.

Requirements

• Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or government regulations.
• Ability to write reports, business correspondence, and procedure manuals.
• Experience with utilizing and developing patient assessments and questionnaires.
• Ability to assess and advise patients via conversation.
• Knowledge to effectively present information and respond to questions from groups of managers, patients, nurses, and physicians.
• Experience with prior authorization, appeals, and SMN preparation
• Ability to define problems, collect data, establish facts, and draw valid conclusions.
• Relentless attention to detail, and the ability to be a creative self-starter and team player.
• The ability to work independently.
• The ability to function in a leadership capacity.
• Excellent oral and written communication skills.
• Excellent organizational plus interpersonal skills.
• Knowledge of the insurance process, Medicare, and Medicaid billing.
• Knowledge of medical/pharmacy terminology and insurance benefit language; ie. EOB’s, deductibles, out-of-pocket, co-insurance, co-pays, etc.
• Ability to define CMS 1500’s, provider numbers, CPT, HCPCs, ICD9, NCPDP, and NDC codes/numbers.
• Patient Assistance Program knowledge
• Ability to motivate a team to produce quality materials within tight timeframes and simultaneously manage several projects
• Ability to participate in and facilitate group meetings
• Willingness to work a flexible schedule, navigate large cities, and travel via air and ground transportation as needed
• Ability to manage on-call services on a rotating schedule
• Reasonable knowledge of technology and information systems, and software applications such as text documents, slide presentations, spreadsheets.
• A Bachelor of Nursing degree is required. RN and BSN preferred.
• Minimum of five (5) years of experience in the field of nursing.

Nice To Haves

• Experience in a specialty pharmacy is a plus.
• Experience with cell and gene therapies.
• Direct patient experience with oral, subcutaneous, and/or IV medications preferred.
• Holds a compact nursing license and is willing to obtain other state licenses as requested by leadership.

Responsibilities

• Welcome new patients and caregivers, create patient profiles, and maintain ongoing system documentation of communications.
• Interpret, assess, and conduct educational support for patients, caregivers, and treatment teams.
• Communicate with prescribers and their agents and the client.
• Conduct insurance verification and follow up for patient coverage and explain benefits to patients, initial and ongoing.
• Process wholesale distribution of specialty product to an authorized facility and follow up on invoices.
• Obtain and maintain prior authorizations and appeals documentation.
• Relay financial and travel assistance information to patients and compliantly execute services.
• Obtain all necessary consent forms.
• Coordinate and schedule patient and caregiver logistics, including transportation and lodging.
• Manage, secure, and utilize travel and logistics platforms and complete expense tracking and reimbursement.
• Ability to travel for multiple days and connect for remote work as needed.
• Dually coordinate field travel to provide in-person support to patients receiving treatment.
• Be the first point of contact for patients and maintain continuity of care through in-person contact, if requested, via travel to specified treatment center cities.
• Regularly follow up with patients to assess and gather treatment and journey-related information.
• Assist in preparing any ad hoc report requests from clients.
• Perform case management services.
• Support Patient Reported Outcomes Survey Protocol.
• Monitor external websites relating to therapy areas.
• Serve as a mentor for new team members.
• Collect and report adverse events reported by patients as outlined in SOPs.
• Monitor and support program metrics.
• Performing other tasks upon request (including special projects as assigned), remaining flexible and adaptable to changes.

Benefits

• Equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level