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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.

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job application

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