Case Manager, CAPS Center Operations

Overview

Title:
Case Manager, CAPS Center Operations

Reports to:
Supervisor, Operations

Summary:

The Case Manager, CAPS Center Operations is responsible for managing all patient referrals from intake through case closure, including but not limited to: benefits investigations, initiation and follow-up on prior authorizations, initiation and follow-up on all authorization denial appeals, procuring necessary documentation for the patient case, and determining financial assistance qualifications.

Responsibilities:

The Case Manager, CAPS Center Operations responsibilities include, but are not limited to the following:

• Communications
  • Performing program welcome calls to patients
  • Performing post Benefits Investigation calls to patients and physicians explaining coverage options
  • Manage all manufacturer Sales Team inquiries unable to be determined by Power BI
  • Manage HCP inquiries as applicable
• Case Management
  • Coordinating and assisting with prior authorizations as applicable
  • Coordinating and tracking status of payer appeals for drug coverage as applicable
  • Coordinating nurse education as needed
  • Triaging all prescriptions to the fulfillment pharmacy as applicable
  • Investigation of financial assistance availability and communication back to patient concerning next steps for action by patient
  • Specialty Pharmacy follow-up
  • Payer follow-up as applicable to facilitate benefits investigation, assistance with prior authorization and/or appeal of a denied coverage
  • Missing information follow-up with patient or HCP as applicable
  • Managing assigned cases and tasks to ensure that performance is within service levels
• Reporting of Adverse Events/ Product Complaint received in accordance with SOP and good manufacturer practices
• Other duties as assigned by management

Critical Skills:

The candidate must possess the following:

• Detail oriented
• Professional telephone etiquette
• Basic computer knowledge
• Ability to multitask effectively
• Ability to recognize emotions and their effects
• Sureness about self-worth and capabilities
• Manage disruptive impulses
• Maintain standards of honesty and integrity
• Take responsibility for performance
• Be adaptable and handle change with flexibility
• Be innovative and open to new ideas
• Achievement driven; constant striving to improve or to meet a standard of excellence
• Align with the goals of the group or organization
• Ready to take initiative and act on opportunities
• Be optimistic and pursue goals persistently despite obstacles and setbacks
• Be service oriented and anticipate, recognize and meet needs of others, including patients and care partners
• Communicate clearly and send clear messages

Education and Experience:

• Bachelor’s degree or (three) 3 years’ experience is required
• Experience in field of social work, nursing, or medical assistance in a busy physician practice or outpatient facility is preferred
• Insurance reimbursement/prior authorization background/experience is preferred
• Bi-lingual in English and Spanish or Chinese/Mandarin is a plus

Physical Demands:

The candidate must possess the following abilities:

• Ability to sit for extended periods of time
• Ability to travel as needed

Any offer of employment is contingent on completion of a background check and drug screen to company standard.