Regional Patient Case Manager 11:30-8

Summit Access Solutions,LLC•Coraopolis, PA

8h•Hybrid

About The Position

The Regional Patient Case Manager (RPCM) 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 acts as a single point of contact for Healthcare Providers (HCPs), patients, and are regionally aligned to field teams. The RPCM 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 will interact directly with external clients such as pharmaceutical manufacturers, specialty pharmacies and payers as well as internal teams including Operations, Non-Commercial Pharmacy and Program Management to navigate challenges and pull through access to therapy.

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, 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

Responsibilities

Primary point of contact and case manager for client and customer needs, inquiries and escalations.
Coordinate all patient and relevant HCP-related support and access services across all functions including but not limited to: support on patient journey calls, 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 14-Day Supply Program.
Apply defined business rules to qualify patients for manufacturer supported programs.
Provide support, education, and status updates to regionally aligned field teams, HCP offices, and patients to ensure efficient referral processing, triaging, and shipment set ups.
Processes PAP requests in a timely fashion and PAP re-approval verification for continued eligibility.
Refer patients to third-party or other foundation programs per program business rules.
Independently and effectively identify adverse events, product complaints, and LTC cases to document and triage as appropriate.
Manage assigned territory using problem solving skills and professional judgement to independently make sound decisions for timely case resolution.
Demonstrate the ability to prioritize and balance the needs of patients, HCP offices and rare disease clients utilizing program business.
Provide concierge-level service to internal and external customers; resolve any customer and client requests in a timely and accurate manner and escalate appropriately.
Collaborate with field teams on account progression and case recovery efforts and provide relevant case status details and updates.
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.