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.