Key Account Case Management- Ophthalmology at Alivia Health

, Puerto Rico, United States -

Full Time

Start Date

Immediate

Expiry Date

19 Feb, 26

Salary

0.0

Posted On

21 Nov, 25

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Case Management, Communication, Customer Service, Relationship Building, Prescription Review, Prior Authorization, Insurance Claims, Patient Assistance Programs, Medication Management, DUR Research, Financial Aid, Documentation, Team Collaboration, Problem Solving, Bilingual Communication, Pharmacy Knowledge

Industry

Health and Human Services

Description

In general, the Key Accounts Case Manager will be responsible for the following tasks: * Review and interpret prescriptions to ensure appropriate therapies. * Review medication policies to ensure compliance with requirements for billing purposes. * Transcribe prescription data in preparation for Pharmacist verification. * Contact all new patients to inform them of prior authorization requirements and welcome them to Alivia Specialty Pharmacy. * Gather all necessary information and documents to support the approval request to the Health Plan or PBM. * Communicate and send necessary documents to insurance companies or other payers to fulfill prior authorization requirements. * Answer incoming pharmacy calls with excellent customer service standards and follow up on pending internal or external tasks. * Meet the quantitative and qualitative production standards set by management. * Obtain the patient’s medication list for DUR research. * Submit and review prescription drug insurance claims to be delivered to patients and providers. * Refer to the Patient Assistance Program department in cases where the patient cannot afford deductibles. * Develop relationships and act as a liaison with physicians, patients, infusion centers, manufacturers, and Patient Assistance Programs. * Identify and resolve rejected requests by health plans, including facilitating access to comparable medication regimens; refer to pharmacist in case of potential pharmaceutical alternatives. * Monitor assistance balances for each enrolled patient to ensure funding is available through the completion of therapy (e.g., financial aid). * Communicate medication deductible as applicable. * Maintain continuous communication with the medical office and/or infusion center. * Identify and follow up on refill dates to ensure patients receive medications on time in accordance with the treatment plan. * Other duties: perform or assist with any operation as needed to maintain workflow and meet timelines and quality standards; participate in meetings and working groups prepared by management or colleagues; stay updated on new developments, requirements, and policies. * Escalate any extraordinary situation to the supervisor or manager; availability to attend weekly meetings. * Other duties as assigned by the supervisor. Minimum Requirements: * Experience in Case Management. * Ability to communicate in English, including reading comprehension, verbal communication, and written communication. * Exemplary communication, customer service, and relationship-building skills with clients; including listening, speaking, and writing in both Spanish and English. * Associate Degree as Pharmacy Technician is required. * Valid Pharmacy Technician license is required. * Specialized training in benefits access and pharmacy/medical requirements is preferred. EEOC F/M/D/V

Responsibilities

The Key Accounts Case Manager will review prescriptions and medication policies, ensuring compliance and appropriate therapies. They will also communicate with patients and insurance companies to facilitate prior authorization and medication access.