Oncology Case Manager at ConnectMed360

Buffalo, New York, United States -

Full Time

Start Date

Immediate

Expiry Date

15 Sep, 26

Salary

0.0

Posted On

17 Jun, 26

Experience

5 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Benefit Verification, Prior Authorization, Patient Outreach, Medication Reimbursement, HIPAA Compliance, Case Management, Patient Education, Insurance Plan Analysis, Interpersonal Communication, Data Entry, Adverse Event Reporting, Relationship Building

Industry

Pharmaceutical Manufacturing

Description

ConnectMed360 is seeking an Oncology Case Manager. This position is Full-Time, remote working Monday - Friday. We offer quarterly incentive bonuses with plenty of growth opportunities! Come and join our Team making a difference for patients with rare diseases! Salary is starting at $60k and up, depending on experience ConnectMed360 is a unique model creating customized patient support programs that connect manufacturers, providers, and patients to simplify the patient journey and deliver specialty medications and coordinated care quickly. A career with us is more than just a job. It's an opportunity to connect and care for our patients, providers, communities and each other. We attract extraordinary people who have a strong desire to live our mission - to better the lives of those battling cancer and rare diseases. Compassion is more important than numbers. We value teamwork, respect, integrity, and passion. We succeed when you do, and our company and management team work hard to foster an environment that provides you with opportunities for both professional and personal growth. We offer a variety of benefits including: * Medical; Dental; Vision * 401k with a match * Paid Time Off and Paid Holidays * Tuition Reimbursement * Company paid benefits – life; and short and long-term disability The Oncology Case Manager plays a key role in ensuring patients get access to an oral oncology medication by working directly with patients, prescribers, prescriber office staff, insurance providers, and care team members to facilitate the payer coverage process and drive holistic patient support. The Oncology Case Manager is responsible for facilitating the medication reimbursement process by supporting all involved in the coverage process, including prescriber office staff, specialty pharmacies and patients and/or their care givers. The Oncology Case Manager manages the reimbursement and supports requests for hub patient enrollments in a specific geography and serves as the primary point of contact for the healthcare providers, patients and Client’s Account Managers in that area. Major Responsibilities for the Oncology Case Manager include: * Perform benefit verification and coverage determination to identify and communicate the patient’s plan benefit coverage including the need for prior authorization, appeal, tier exception, and/or formulary exclusions * Support the facilitation of prior authorization and appeal processes by gathering necessary clinical documentation and information, with guidance from senior team members as needed * Screen, enroll, and educate eligible patients of free goods programs where applicable as per program business rules * Perform patient outreach as needed to facilitate prescription fulfillment and therapy adherence as per program rules * Comprehensively understand the benefits investigation process, insurance plans, and available patient assistance programs * Operate both inbound and outbound calls as per the program-approved Frequently Asked Questions (FAQs), Call Guides, Call Scripts, and other program-approved material * Field inbound calls from prescribers, patients and client’s account teams as directed by the program approved FAQs * Inform and support patients by providing education and information throughout their therapy journey as to the status of their medication, needed processes, and connection to other stakeholders providing support like their Oncology treatment care team or pharmacy * Assist in monitoring and maintaining the reauthorization of insurance coverage process to ensure continuity of therapy access * Serve as primary point of contact for incoming phone calls from patients, caregivers, physicians and client's department teams. Proactively provides updates to internal and external stakeholders on patient cases in a timely manner. * Create trusting relationships with physician offices and client department teams in their assigned region(s). * Conduct scripted welcome calls and ongoing educational support calls to patients and office staff to introduce the program and confirm required enrollment information as necessary. * Demonstrate an understanding of business rules, work instructions, and company-approved communications for patients and HCPs. Comprehensively understand the benefits investigation process, plan design, prior authorization criteria and processes, and all available patient support program offerings. * Navigate operating platform with ease. Document and meticulously make notations in each patient’s profile regarding every update and aspect of patient’s journey. * Uses discretion and independent judgment in handling customer complaints received, while documenting and forwarding to appropriate team members. * Communicate with Directors, Team Leads, Supervisor and Program Manager on noteworthy program updates or obstacles. * Demonstrate an understanding of business rules, work instructions, and program-approved scripts, guides and other communications for patients and HCPs. * Communicate with specialty pharmacies to obtain patient case updates and ensure the prescription process is moving forward. Coordinate with Non-Commercial Pharmacy and schedule shipments as needed. * Must exhibit excellent skills in the following areas: verbal/written communication, computer/data entry/software proficiency, interpersonal and relationship-building skills, self-discipline, attention to detail, and the ability to maintain strict confidentiality. * Reporting of Adverse Events/ Product Complaint received in accordance with SOP and good manufacturer practices * Other duties as assigned by management Qualifications for the Oncology Case Manager include: Education/Learning Experience * Required: High School Diploma or equivalent * Desired: Bachelor’s or associate degree OR equivalent program from a two-year college or technical school, or certificate program in pharmacy and/or healthcare field, preferred. Certification preferences include PACS (Prior Authorization Certified Specialist), CHES (Certified Health Education Specialist) CCM in healthcare or social science (Certified Case Manager) or Social Worker Field Work Experience * Required: Minimum of 5 years of pharmacy experience * Desired: Minimum of 2 Years of patient support program experience Skills/Knowledge * Strong verbal and written communication skills with the ability to adapt communication style and word choice to effectively convey information to various audience types, inclusive of patients, healthcare providers and cross-functional teams * Proactive mindset where potential challenges are anticipated and initiative is taken towards effective solutions to support patients, providers, and care team members through access issues to ensure timely resolution and to prevent delays in treatment initiation * Working knowledge and experience with health insurance (pharmacy benefit), Medicare Part D coverage, prior authorization processes, and medication reimbursement specifically for specialty drugs * Working knowledge of US health care policies and relevant legal, compliance, regulatory requirements * Understands HIPAA and privacy laws and requirements and maintains patient confidentiality * Experience with Adverse Event and Product Quality Complaint reporting * Limited travel may be required for trips to company meetings, key customer meetings, or other association meetings as determined by leadership Licenses/Certifications * Required: N/A * Desired: Pharmacy Technician, PACS (Prior Authorization Certified Specialist), CHES (Certified Health Education Specialist) or CCM in healthcare or social science (Certified Case Manager)

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Responsibilities

Facilitate the medication reimbursement process and payer coverage for oncology patients by coordinating between providers, insurance, and pharmacies. Provide holistic patient support and education to ensure therapy adherence and timely access to specialty medications.