Case Manager

Role Overview

Join our dynamic team as a Benefits Investigation Specialist and be a crucial part of ensuring access to essential medications. The Case Manager's primary duty is to assist customers with chronic illnesses in their assigned territory by gaining access to their wellbeing needs, journey and treatment plan.

What You Will Do

Manage the Care Coordination process within an assigned territory, establish and maintain professional relationships with internal and external customers, assess physicians' needs, and develop action plans to proactively mitigate delays in therapy.

Why It Might Be a Fit

We seek a compassionate individual to engage with Medical Insurance Payers and Pharmacy Benefit Managers, playing a vital role in identifying and documenting coverage options for retail and specialty medications. The Case Manager will utilize care coordination to address patient and physician concerns, and obtain insurance approval for designated therapy.

Requirements

• Bachelor's Degree (or equivalent) in related area with focus in Health Care, Social Work, Nursing, preferred
• Minimum of three (3) years of recent experience with health care insurance benefits, relevant state and federal laws, and insurance regulations
• Proven ability to assess the ethics and legality of patient care
• Recent experience in the case management process is preferred
• Experience in a combination of home care management, case management review, utilization review, social service support, insurance reimbursement and patient advocacy, preferred
• In-depth understanding of health care insurance benefits, relevant state and federal laws and insurance regulations, highly desired
• Experience with data entry/computer literate skills, preferred
• Exhibits a high level of case management expertise and demonstrated leadership skills
• Strong verbal and written communication skills, including effectively communicating with clients/providers/patients and employees of ConnectiveRx in a professional and courteous manner
• Mediation, and problem-solving skills
• Ability to speak Spanish is a plus
• Ability to identify and handle sensitive issues with opposing opinions
• Proven ability to work independently and handle projects or multiple tasks

Benefits

• bonus (or commissions)
• medical insurance
• dental insurance
• vision insurance
• life insurance
• disability insurance
• 401(k) plan with employer contributions
• flexible paid time off (PTO) policy
• eight standard company holidays
• three floating holidays annually