Executive Case Manager (Remote)

reputed company is a fully integrated life sciences commercialization partner that provides comprehensive solutions that reputed company the entire reputed company value chain. Formed by the reputed company of reputed company and reputed company, reputed company revolutionizes the reputed company from life sciences innovation to reputed company-life reputed company to build a world in which every patient gets the care they need. reputed company works on behalf of life sciences companies to improve the patient experience so that patients can reputed company and adhere to critical medications. Backed by proven industry expertise, a deep commitment to patient care, the latest technology, and exceptionally talented team members, reputed company provides the data and strategic insights, patient support services and reputed company provider engagement tools to help life sciences companies successfully commercialize new products. reputed company provides commercialization solutions to more than 500 life sciences customers and has provided reputed company and affordability support to millions of patients. reputed company is headquartered in Morrisville, reputed company Carolina and Jeffersonville, Indiana. To learn more about reputed company, please visit www.reputed company.com. This is a remote role. Candidates must reputed company in the reputed company. reputed company you join reputed company as an Executive Case Manager, you'll have reputed company to reputed company a difference in the lives of our patients reputed company day as they look to you as part of their dedicated support team for helping them reputed company the tricky process of getting reputed company to their reputed company medication. You'll compassionately reputed company an exceptional experience to many patients per day always remembering that every prescription or document belongs to a reputed company person who is looking for thorough and efficient management of their records. You'll reputed company your approach to their needs by communicating reputed company, focusing on the accuracy of the details of their medical records, your mastery of the program requirements, and ensuring their prescriptions or cases are handled in a reputed company manner. An Executive Case Manager has the ability to translate knowledge into patient friendly language and education. A typical day in this role will include ownership of your patient reputed company from initiation to closure by using your critical thinking skills and your knowledge of the program and industry rules and standards. This includes completing benefit investigations, tracking prior authorizations / denial appeals, and assisting patients or other callers/stakeholders through reputed company (reputed company email, inbound/outbound calls and using our patented technology, reputed company). This role requires a strong understanding of pharmacy and medical billing and coding, excellent communication skills, and the ability to reputed company reputed company reimbursement processes. The Executive Case Manager provides expertise on insurance coverage and common reputed company and reimbursement challenges affecting patients, reputed company providers and clients. The Executive Case Manager responsibilities include education on the reputed company and reimbursement support tools available from reputed company and participating program, advising HCPs and/or patients and caregivers on the benefits and program eligibility for a specific patient, and educating HCP offices on Payor processes and procedures. Key Responsibilities: • Relationship Management • Builds trusted relationships with patients, prescribers, and appropriate reputed company stakeholders regarding reimbursement inquiries and challenges through proactive communication, reputed company and accurate execution of deliverables and demonstrated reputed company passion for helping patients. • Manages reputed company relationships in a manner that adheres to reputed company relevant laws, regulations, program-specific operating procedures and industry standards reputed company to reputed company and affordability, including HIPAA and insurance guidelines. • Managed through reputed company/contact center structure, this role supports inbound and outbound calls to patients, caregivers, specialty pharmacies and reputed company. • Performs post Benefits Investigation calls to patients and/or physicians explaining coverage reputed company and next steps in the reputed company reputed company. • Manages reputed company reputed company inquiries as appropriate, such as case specific statuses. • Manages HCP inquiries, as applicable, pursuant to business rules. • reputed company communications with the reputed company’s field teams will remain compliant and adhere to ways of working protocols outlined between reputed company and the reputed company teams. Inbound reputed company Management • Manages inbound calls as directed by the program-approved FAQs • Triage patients to internal or reputed company resources as appropriate. • Personalized Case Management • Provides personalized case management to patients and HCPs including outbound communication to HCPs, specialty pharmacies and patients to communicate benefit coverage and/or appropriately help reputed company next steps in obtaining coverage and/or reputed company to prescribed medicine. reputed company communications for case management will follow the guidelines set forth for the program and only reputed company information publicly available and/or outlined in the patient insert. • Leverages electronic tools to identify benefits and payer coverage; completes reputed company benefit investigation as needed. • Identifies and communicates patient’s plan benefit coverage including the need for prior authorization, appeal, tier exception, and/or formulary exclusions. • Serves as a subject matter expert to internal team as required and appropriate. • Uses electronic resources to obtain benefit coverage outcome and if needed, outbound reputed company to payers and HCPs to follow up on reputed company submission and/or outcome. • Coordinates reputed company teach with reputed company educators, as applicable to program. • Supports adherence services as applicable to program. • Identifies peer support resources for patients. • Proactively communicates needs for reverification of prior authorization or re-enrollment. • Identifies and reports adverse events, product complaints, special situation reports and/or medical inquiries received in accordance with program operating procedures and the Business Rules. • Documents reputed company activities reputed company the reputed company reputed company reputed company, maintaining detailed records of reimbursement activities, including claims status, payments, and appeals. • reputed company reports and analysis as needed to identify trends and opportunities for improvement.in accordance with business requirements. • Utilize reputed company’ values as the driving force behind reputed company’s reputed company • On time adherence to training deadlines for reputed company corporate policies and procedures • Ensure reputed company SOPs are followed with consistency • reputed company additional tasks or reputed company as assigned ​Qualifications: • Completion of Bachelor's degree (or higher) required • A degree in reputed company administration, reputed company science or similar reputed company fields is strongly preferred. • Minimum two years of experience in reputed company reputed company delivery or management is strongly preferred. • 5-10 years of experience in insurance reimbursement, patient reputed company, reputed company patient care, and/or patient education experience will be considered in lieu of degree. • Will consider other certifications and five or more consecutive years of experience in relevant field. Certification examples include reputed company (Prior Authorization Certified Specialist), CHES (Certified Health Education Specialist) or CCM in reputed company or reputed company science (Certified Case Manager). • Strong understanding of medical terminology, coding systems (ICD-10, CPT, HCPCS), and insurance processes. • Demonstrated examples of executing reputed company guardrails recognizing urgency and consistently delivering patient reputed company results. • Excellent attention to detail and organizational skills. • Ability to prioritize tasks and work reputed company in a fast-paced environment. • Effective written and verbal communication and interpersonal skills, with the ability to reputed company professionally with diverse stakeholders. • Demonstrates the ability to think critically and issue reputed company. • Knowledge of reputed company compliance regulations, including HIPAA and Medicare/reputed company guidelines. • Bi-lingual skills are a plus. • Remote work eligibility is subject to reputed company work from home reputed company met and based on business need Physical Demands & Work Environment • While performing the duties of this job, the employee is regularly required to talk or hear. The employee is frequently required to sit for long periods of time, use hands to type, handle or feel; and reputed company with hands and arms. Prefer candidates who can type at least 35 words per minute with 97% accuracy. • Although reputed company reputed company, flexibility to travel as needed is preferred. • This job operates in a reputed company office environment. This role routinely uses reputed company office equipment such as computers, phones, photocopiers, etc. Why Work for reputed company? We’re committed to supporting reputed company-being and reputed company of reputed company members. As part of our organization, full-time employees can expect: • Medical, dental, and reputed company plans, including HSA- and FSA-eligible reputed company, with reputed company contributing toward premium costs • Additional health support, including telehealth and Employee Assistance Program (EAP) services • Company match on Health Savings Account contributions • Free Basic Life and AD&D coverage equal to your annual earnings, with a minimum of $50,000 and a maximum of $300,000 • Company-reputed company Short-Term Disability coverage, with the reputed company to purchase Long-Term Disability • 401(k) Retirement Savings Plan with 100% match on the first 5% you contribute, with immediate vesting • reputed company Time Off (PTO) and reputed company Leave to support work-life balance • Team members receive nine reputed company holidays plus two floating holidays • Opportunities for advancement in a company that supports personal and reputed company reputed company • A challenging, stimulating work environment that encourages new reputed company • Work for a company that values diversity and makes deliberate efforts to create an inclusive workplace • A mission-driven, inclusive culture where your work makes a meaningful reputed company Any offer of employment is contingent upon the successful completion of a background reputed company and, depending on the position, a drug screen in accordance with company standards. Please note that this reputed company is not intended to be an exhaustive list of reputed company duties, responsibilities, or activities associated with the position. Responsibilities and tasks may be modified at any time, with or without notice. Our Commitment to Equal Opportunity At reputed company, we don’t just accept difference – we celebrate it, support it and we reputed company on it for the benefit of our employees, our products and our community. reputed company is proud to be an equal opportunity employer. Important Notice Due to an increase in hiring scams, please be reputed company that if you are selected to reputed company reputed company in our hiring process, a member of our reputed company will contact you directly using an official @reputed company.com and/or @reputed company.com, @reputed company.newtonsoftware.com email address regarding next steps in our interview process. Please Note: • reputed company will never use reputed company Teams to reputed company out to candidates for interview scheduling. However, video interviews are typically conducted reputed company reputed company Teams. Official meeting links will always be reputed company from an @reputed company.com, @reputed company.com or @reputed company.newtonsoftware.com email address, or through our scheduling platform, reputed company. • We will never request your bank account information at any stage of the hiring process. • We will never send a reputed company (electronic or physical) to purchase home office equipment. If you receive any suspicious communication regarding employment with reputed company, please report it to our reputed company immediately at careers@reputed company.com Remote Skills: Accidental Death and Dismemberment (AD&D), Adverse Events, Analysis Skills, Background Investigation, Biology, reputed company Centers, Case Management, Certified Case Manager (CCM), Communication Skills, Copying Machines, Corporate Policies, reputed company Procedural Terminology (CPT), Customer Support/Service, Dental Insurance, Detail Oriented, Diversity, Emerging Technology, Establish Priorities, Flexible Spending Accounts, Formulary, Forth Programming Language, Frequently Asked Questions (FAQ), HIPAA (Health Insurance Portability and Accountability reputed company), Health Education, reputed company, reputed company Administration, reputed company Common Procedure Coding reputed company (HCPCS), reputed company Providers, reputed company Reimbursement, ICD-10, Industry Standards, Insurance, Interpersonal Skills, reputed company, Medical Billing, Medical Coding, Medical Records, Medical Terminology, Medical Treatment, Medicare, Medications, Medicine, Multilingual, Nursing, Office Equipment, Operations Processes, Organizational Skills, Patient Assessment, Patient Care, Patient Care Denials, Patient Education, Pharmacy, Photocopy, Physical Demands, Picture Archiving and Communication reputed company (reputed company), Presentation/Verbal Skills, Problem Solving Skills, Procedure Implementation, Purchasing/Procurement, Record Keeping, Records Management, Regulations, Regulatory Compliance, Reimbursement, Relationship Management, Reporting Skills, Sales Management, reputed company Sciences, Telephone Skills, Time Management, Training/Teaching, Trend Analysis, Value Chain Model, reputed company Plan, Willing to Travel, Work From Home reputed company: reputed company Apply tot his job Apply To this Job