Job Description

Job Description

Job Description

Purpose:

The Regional Case Manager is a professional client facing role responsible for various functions, including accurate and timely response to client inquiries regarding specific patient assistance program (PAP) referral status or escalation. The Regional Case Manager serves as a primary point of contact for professional, concise internal and external communication regarding case status updates, next steps in prescription processing, shipment set ups, communication of reimbursement issues, etc. The Regional Case Managers will interact directly with external clients such as manufacturers, specialty pharmacies, payers as well as internal teams including Operations, Non-Commercial Pharmacy and Program Management.

Responsibilities:

• Primary point of contact and case manager for client and customer inquiries and escalations.

• Coordinates services with internal program operations and Program Management.

• Manages assigned territory using problem solving skills and professional judgement to independently make sound decisions for timely case resolution.

• Demonstrates daily the ability to prioritize and balance the needs of the patients, HCP offices and client within the business rules of the program.

• Provides exceptional, white glove, customer service to internal and external customers; resolves any customer and client requests in a timely and accurate manner; escalates appropriately.

• Provides support to Patient Access Liaisons, HCP offices and patients to ensure efficient referral processing, triaging, and shipment set ups.

• Processes PAP requests in a timely fashion as well as PAP re-approval verification for continued eligibility.

• Ability to coordinate and collaborate with manufacturer representatives, HCP offices and other key personnel on complex cases which require strategic intervention. Independently and effectively resolves complex issues with creativity and innovation while maintaining compliance.

• 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.

• Active participation in building and maintaining respectful, collaborative team relationships, exercising, and encouraging positivity.

• Other duties as assigned

Required Qualifications:

• High school diploma plus 2+ years recent case management experience

• Previous 2+ years of experience in a pharmacy, healthcare setting, and/or insurance background.

• Advanced knowledge and experience in healthcare setting

• Ability to communicate effectively both orally and in writing with a focus on customer satisfaction

• Ability to independently manage case load, prioritize work, and use time management skills to manage deliverables

Preferred Qualifications:

• College degree (bachelor or associates) preferred.

• Certified Pharmacy Technician or Case Management Experience

• Strong analytical and organizational skills with meticulous attention to detail.

• Experience with benefit investigation and verification of prescription benefits

• Working knowledge of Third-Party and other Foundation programs a major plus

• Understanding of plan types – Government, Commercial, Medicaid, VA, Fed

• Knowledge of insurance structure (ex PBM’s, major medical plans, co-pay assistance /cards)

• Ability to proficiently use Microsoft Excel, Outlook and Word

• Ability to build productive internal/external working relationships

• Strong interpersonal skills

• Empathy, drive, and commitment to exceptional service

Work Environment

RareMed offers a hybrid work structure, combining remote work and in-office requirements. The frequency of onsite requirements will vary depending on role, operational needs, meetings, client visits, or team collaboration activities. Employees must be within commuting distance to Pittsburgh, PA, and able to report to the office when needed. We will provide advance notice when possible. This role routinely involves standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines. When telecommuting, employees must have reliable internet access to utilize required systems and software required for the position's responsibilities. The amount of time the employee is expected to work per day or pay period will not change while working from home. Employees are responsible for the set-up of their home office environment, including physical set-up, internet connection, phone line, electricity, lighting, comfortable temperature, furniture, etc. Employee’s teleworking space should be separate and distinct from their “home space” and allow for privacy.

Physical Demands
While performing the duties of this job, the employee is regularly required to talk or hear. The employee frequently is required to stand; walk; use hands and fingers, handle or feel; and reach with hands and arms.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function of the job.

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