Executive Case Manager (Remote)Valeris • Indiana, Pennsylvania, United States
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Executive Case Manager (Remote)
Valeris
- Indiana, Pennsylvania, United States
- Indiana, Pennsylvania, United States
À propos
Key Responsibilities
Relationship Management
Build trusted relationships with patients, prescribers, and relevant client stakeholders regarding reimbursement inquiries and challenges through proactive communication, timely and accurate execution of deliverables, and a relentless passion for helping patients.
Manage all relationships in a manner that adheres to all relevant laws, regulations, program‑specific operating procedures, and industry standards related to access and affordability, including HIPAA and insurance guidelines.
Support inbound and outbound calls to patients, caregivers, specialty pharmacies, and healthcare professionals via a call/contact center structure.
Perform post‐benefit investigation calls to patients and/or physicians, explaining coverage options and next steps in the access journey.
Manage all client inquiries and HCP inquiries as appropriate, pursuant to business rules.
Ensure all communications with the client’s field teams remain compliant and adhere to agreed protocols between PharmaCord and the client teams.
Inbound Call Management
Manage inbound calls as directed by the program‑approved FAQs.
Triage patients to internal or external resources as appropriate.
Personalized Case Management
Provide personalized case management to patients and HCPs, including outbound communication to HCPs, specialty pharmacies, and patients to communicate benefit coverage and/or drive next steps in obtaining coverage and access to prescribed medicine.
Leverage electronic tools to identify benefits and payer coverage; complete manual benefit investigations as needed.
Identify and communicate patient’s plan benefit coverage, including prior authorization, appeal, tier exception, and formulary exclusions.
Serve as a subject matter expert to the internal team as required and appropriate.
Use electronic resources to obtain benefit coverage outcome; perform outbound calls to payers and HCPs to follow up on submission and/or outcome.
Coordinate nurse teaching with nurse educators as applicable to the program.
Support adherence services as applicable to the program.
Identify peer support resources for patients.
Proactively communicate needs for reverification of prior authorization or re‑enrollment.
Identify and report adverse events, product complaints, special situation reports, and medical inquiries in accordance with program operating procedures and business rules.
Document all activities within the PharmaCord Lynk system, maintaining detailed records of reimbursement activities, including claims status, payments, and appeals.
Generate reports and analyses to identify trends and opportunities for improvement, in accordance with business requirements.
Utilize Valeris’ values as the driving force behind team success.
Adhere to training deadlines for all corporate policies and procedures.
Ensure all SOPs are followed consistently.
Perform additional tasks or projects as assigned.
Qualifications
Completion of Bachelor's degree (or higher) required.
Degree in healthcare administration, social science, or related fields strongly preferred.
Minimum two years of experience in healthcare access delivery or management strongly preferred.
5‑10 years of experience in insurance reimbursement, patient access, direct patient care, and/or patient education considered in lieu of a degree.
Other certifications and five or more consecutive years of experience in a relevant field will be considered. Examples include PACS, CHES, or CCM.
Strong understanding of medical terminology, coding systems (ICD‑10, CPT, HCPCS), and insurance processes.
Demonstrated ability to execute within guardrails, recognize urgency, and consistently deliver patient‑centric results.
Excellent attention to detail and organizational skills.
Ability to prioritize tasks and work efficiently in a fast‑paced environment.
Effective written and verbal communication and interpersonal skills, with the ability to interact professionally with diverse stakeholders.
Demonstrated critical thinking and issue‑resolution skills.
Knowledge of healthcare compliance regulations, including HIPAA and Medicare/Medicaid guidelines.
Bi‑lingual skills are a plus.
Remote work eligibility is subject to all work‑from‑home criteria met and based on business need.
Physical Demands & Work Environment
Job requires frequent talking or hearing, sitting for long periods, using hands to type, and reaching with arms. Candidates should type at least 35 words per minute with 97% accuracy.
Minimal travel flexibility preferred.
Work occurs in a professional office environment using standard office equipment such as computers, phones, and scanners.
Benefits
Medical, dental, and vision plans, including HSA‑ and FSA‑eligible options, with Valeris contributing toward premium costs.
Additional health support, including telehealth and Employee Assistance Program services.
Company match on Health Savings Account contributions.
Free Basic Life and AD&D coverage equal to your annual earnings, with minimum $50,000 and maximum $300,000.
Company‑paid Short‑Term Disability coverage, with option to purchase Long‑Term Disability.
401(k) Retirement Savings Plan with 100% match on first 5% contribution, immediately vesting.
Paid Time Off and Sick Leave.
Nine paid holidays plus two floating holidays.
Opportunities for advancement in a company that supports personal and professional growth.
A challenging, stimulating work environment that encourages new ideas.
Work for a company that values diversity and creates an inclusive workplace.
A mission‑driven culture where your work makes a meaningful impact.
Equal Opportunity Statement At Valeris, we celebrate differences, support them, and thrive for the benefit of our employees, products, and community. Valeris is an equal opportunity employer.
Additional Information Any offer of employment is contingent upon successful completion of a background check and, where applicable, a drug screen in accordance with company standards. This job description is not intended to be an exhaustive list of all duties, responsibilities, or activities associated with the position. Responsibilities and tasks may be modified at any time, with or without notice.
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Compétences linguistiques
- English
Avis aux utilisateurs
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