Patient Navigator

at  Cardinal Health

The Patient Navigators perform case management supporting patient access to therapy in accordance with the program business rules. This position is responsible for guiding the patient and healthcare provider through the various process steps of their patient journey to therapy. These steps include relaying benefit information to both patient and healthcare providers, conducting patient welcome calls and follow up calls to assist patients, patient caregivers and healthcare providers, as well as assist with any prior authorizations or appeals to facilitate coverage and dispense of product in a timely manner.

QUALIFICATIONS

• 0-2 years of experience, preferred
• BA, BS or equivalent experience in related field, preferred
• Previous social work experience is preferred
• LVN is preferred
• 2-4 years of Case Management experience is preferred
• Demonstrate effective, empathetic and professional communication
• Clear knowledge of Medicare (A, B, C, D)
• 1-2 years of Pharmacy and/or Medical Claims billing and Coding work experience is preferred
• 1-2 years of experience with Prior Authorization and Appeal submissions
• Must be able to manage multiple concurrent assignments
• Must communicate clearly and effectively in both a written and verbal format
• Ability to work with high volume production teams with an emphasis on quality
• Able to thrive in a competitive and dynamic environment
• Intermediate to advanced computer skills and proficiency in Microsoft Office including but not limited to Word, Outlook, and preferred Excel capabilities
• Previous medical experience is preferred

QUALIFICATIONS

• 0-2 years of experience, preferred
• BA, BS or equivalent experience in related field, preferred
• Previous social work experience is preferred
• LVN is preferred
• 2-4 years of Case Management experience is preferred
• Demonstrate effective, empathetic and professional communication
• Clear knowledge of Medicare (A, B, C, D)
• 1-2 years of Pharmacy and/or Medical Claims billing and Coding work experience is preferred
• 1-2 years of experience with Prior Authorization and Appeal submissions
• Must be able to manage multiple concurrent assignments
• Must communicate clearly and effectively in both a written and verbal format
• Ability to work with high volume production teams with an emphasis on quality
• Able to thrive in a competitive and dynamic environment
• Intermediate to advanced computer skills and proficiency in Microsoft Office including but not limited to Word, Outlook, and preferred Excel capabilities
• Previous medical experience is preferred

RESPONSIBILITIES

• Deliver virtual or telephonic educational support to identified patients, caregivers, Healthcare Professionals (HCPs) and their staff to meet all relevant standards as set by the client company
• Be a champion for each patient and consented care partner(s)
• Answer inbound inquiries of patients, care partners and HCPs
• Act as primary point of contact for patients and HCPs
• Understand a patient’s support needs and interaction preferences to deliver a seamless, tailored patient experience that helps each patient complete their pathway to treatment as prescribed by their HCP
• Establish an ongoing relationship with each assigned patient, starting with Welcome, onboarding, treatment initiation, continuation, and ongoing interactions
• Provide support and guidance to help ensure patients have access to the patient support program resources by compliantly navigating reimbursement, and mitigating any patient out-of-pocket barriers, as applicable
• Experience in supporting time sensitive requests and prioritization of assignments and working with a sense of urgency.
• Investigate and resolve patient/healthcare provider inquiries and concerns in a timely manner
• Work closely with patients, patient caregivers, healthcare providers. Sonexus Health reimbursement team, the manufacturer’s employees, third party vendors to clearly identify issues and provide resolution.
• Responsible for meeting the newly identified patient, patient caregivers, healthcare providers over the phone to provide education on the drug, disease process, diagnostic testing, support services provided by the manufacturer and review benefit information.
• Patient Navigators work closely with the Case Managers to coordinate care and educational opportunities for patients, patient caregivers, and healthcare providers regarding the patient journey.
• Support healthcare providers with Prior Authorization and Appeals submission to Insurance carrier.
• Exhibit effective communication and tele-management skills.
• Proactive follow-up with various contacts to ensure patient access to therapy.
• Converse with callers in an empathetic manner and build rapport
• Act as patient and healthcare providers single point of contact for all inquiries
• Possess effective organizational skills, including working on multiple cases simultaneously.
• Responsible for the identification, intake, documentation, and submission of all Adverse Event Reports occurring in patients which are taking or have previously taken the manufacturer’s product.
• Submit all adverse event reports to manufacturer/third party vendor within stipulated timeframe; additionally follow up if requested to do so.
• Responsible for addressing Medical Information inquiries from consumers, healthcare providers and other entities, including but not limited to, requests for product information, inquiries about side effects, guidelines for appropriate use of the product, etc.
• Provide identification, intake, documentation, and submission of all reported Product Complaints, per the manufacturer guidelines.
• Perform other activities related to the internal initiatives and/or the manufacturer’s programs as assigned.
• Responsible for maintaining HIPAA guidelines.
• Must adhere to strict guidelines regarding the protection of proprietary educational materials and product information that may be printed or available via email, websites, or other electronic means, provided by the manufacturer.
• Concurrently handle multiple outstanding issues and ensure all items are resolved in a timely manner to the satisfaction of all parties

RESPONSIBILITIES

• Deliver virtual or telephonic educational support to identified patients, caregivers, Healthcare Professionals (HCPs) and their staff to meet all relevant standards as set by the client company
• Be a champion for each patient and consented care partner(s)
• Answer inbound inquiries of patients, care partners and HCPs
• Act as primary point of contact for patients and HCPs
• Understand a patient’s support needs and interaction preferences to deliver a seamless, tailored patient experience that helps each patient complete their pathway to treatment as prescribed by their HCP
• Establish an ongoing relationship with each assigned patient, starting with Welcome, onboarding, treatment initiation, continuation, and ongoing interactions
• Provide support and guidance to help ensure patients have access to the patient support program resources by compliantly navigating reimbursement, and mitigating any patient out-of-pocket barriers, as applicable
• Experience in supporting time sensitive requests and prioritization of assignments and working with a sense of urgency.
• Investigate and resolve patient/healthcare provider inquiries and concerns in a timely manner
• Work closely with patients, patient caregivers, healthcare providers. Sonexus Health reimbursement team, the manufacturer’s employees, third party vendors to clearly identify issues and provide resolution.
• Responsible for meeting the newly identified patient, patient caregivers, healthcare providers over the phone to provide education on the drug, disease process, diagnostic testing, support services provided by the manufacturer and review benefit information.
• Patient Navigators work closely with the Case Managers to coordinate care and educational opportunities for patients, patient caregivers, and healthcare providers regarding the patient journey.
• Support healthcare providers with Prior Authorization and Appeals submission to Insurance carrier.
• Exhibit effective communication and tele-management skills.
• Proactive follow-up with various contacts to ensure patient access to therapy.
• Converse with callers in an empathetic manner and build rapport
• Act as patient and healthcare providers single point of contact for all inquiries
• Possess effective organizational skills, including working on multiple cases simultaneously.
• Responsible for the identification, intake, documentation, and submission of all Adverse Event Reports occurring in patients which are taking or have previously taken the manufacturer’s product.
• Submit all adverse event reports to manufacturer/third party vendor within stipulated timeframe; additionally follow up if requested to do so.
• Responsible for addressing Medical Information inquiries from consumers, healthcare providers and other entities, including but not limited to, requests for product information, inquiries about side effects, guidelines for appropriate use of the product, etc.
• Provide identification, intake, documentation, and submission of all reported Product Complaints, per the manufacturer guidelines.
• Perform other activities related to the internal initiatives and/or the manufacturer’s programs as assigned.
• Responsible for maintaining HIPAA guidelines.
• Must adhere to strict guidelines regarding the protection of proprietary educational materials and product information that may be printed or available via email, websites, or other electronic means, provided by the manufacturer.
• Concurrently handle multiple outstanding issues and ensure all items are resolved in a timely manner to the satisfaction of all parties