Hybrid Regional Patient Case Manager – Long Term Care

at RareMed Solutions

• Job title: Regional Patient Case Manager – Long Term Care
• Job type: Full Time
• Experience level: Mid level, Senior
• Salary: Not specified
• Degree requirement: High School Diploma
• Location requirements: Hybrid, Coraopolis, United States

About the role

• Regional Patient Case Manager provides support for long-term care residents and manages communications with healthcare professionals. This role involves multiple responsibilities across facilities and coordination efforts.

Responsibilities

• Serve as the point of contact for regionally aligned field team related to cases identified as LTC to initiate and support therapy to residents of long-term care facilities
• Coordinate all LTC facility-related support and access services across all functions but not limited to: support on patient journey calls, benefits verification, prior authorization and appeals, triage to specialty pharmacy or Long-Term Care Pharmacies, and any necessary follow ups
• Maintain clear, concise, and accurate documentation on all accounts according to Standard Operating Procedures
• Review and add LTC profile data to capture the key information related to LTC facilities and customers
• Conduct initial welcome calls to LTC facility-designated champions and/or patients/caregivers informing them of available services as well as future targeted outreach to provide ongoing support
• Maintain frequent touchpoints through outreach to LTC providers and patients/caregivers to communicate progress throughout their journey
• Work independently to complete assigned work in accordance with Standard Operating Procedures and defined service levels to complete program enrollment, answer inquiries, and coordinate access to free 14-Day Supply Program, if applicable
• Independently and effectively identify adverse events and/or product complaints to document and triage as appropriate
• Apply defined business rules to qualify patients for manufacturer supported programs
• Interact and coordinate with internal program operations, including reimbursement, and program management to ensure provider and patient needs are met in addition to attending any regularly scheduled calls
• Provide support, education and status updates to regionally aligned field teams, LTC facility staff, patients and caregivers to ensure efficient referral processing, triaging, and shipment set ups
• Manage assigned territory using problem solving skills and professional judgement to independently make sound decisions for timely case resolution
• Ability to coordinate and collaborate with manufacturer representatives, LTC facilities and other key personnel on complex cases which require strategic intervention
• Independently and effectively resolves complex issues with creativity and innovation while maintaining compliance
• Refer patients to third-party or other foundation programs per program business rules
• Manage case triage to Specialty Pharmacy or Long Term Care Pharmacy, if applicable, and ensure proper information has been communicated to the Specialty Pharmacy Liaison
• Collaborate with Long Term Care Pharmacies and field teams on account progression and case recovery efforts and provide relevant case status details and updates
• Process PAP requests, when applicable per program business rules, in a timely fashion and PAP re-approval verification for continued eligibility
• Demonstrate the ability to prioritize and balance the needs of patients, LTC facility staff and rare disease clients utilizing program business rules
• Provide concierge-level service to internal and external customers; resolve any customer and client requests in a timely and accurate manner; escalate appropriately
• Maintain frequent phone/email contact with internal operational staff, external client , external specialty pharmacies, providers and payers
• Utilizes outbound faxes, email alerts, and mailings per program guidelines
• Strong compliance mindset, demonstrating clear understanding of patient privacy laws
• Actively participate in building and maintaining respectful, collaborative team relationships, exercising, and encouraging positivity
• Other duties as assigned including cross training to support all Regional Patient Case Manager activities when needed

Requirements

• High school diploma plus 2+ years recent case management experience
• Previous 3+ years of experience in a pharmacy, healthcare setting, and/or insurance background preferably in long term care reimbursement or disability care
• Advanced knowledge and experience in healthcare setting
• Strong interpersonal skills; ability to communicate effectively both orally and in writing with a focus on customer satisfaction
• Empathy, drive and commitment to exceptional service
• Ability to build productive internal/external working relationships
• Ability to independently manage case load, prioritize work, and use time management skills to meet deliverables

Benefits

• Hybrid work structure, combining remote work and in-office requirements
• Must be within commuting distance to Pittsburgh, PA
• Flexible scheduling