Oncology Case Manager

Overview

Connect Med
360 is seeking an Oncology Case Manager. This Full-Time, hybrid position runs Monday - Friday. We offer quarterly incentive bonuses with plenty of growth opportunities. Salary is starting at $60k and up, depending on experience. Connect Med
360 is a unique model creating customized patient support programs that connect manufacturers, providers, and patients to simplify the patient journey and deliver specialty medications and coordinated care quickly. A career with us is an opportunity to connect and care for our patients, providers, communities and each other. We value teamwork, respect, integrity, and passion.

We offer a variety of benefits including Medical;
Dental;
Vision; 401k with a match;
Paid Time Off and Paid Holidays;
Tuition Reimbursement;
Company paid benefits – life; and short and long-term disability.

• The Oncology Case Manager plays a key role in ensuring patients get access to an oral oncology medication by working directly with patients, prescribers, prescriber office staff, insurance providers, and care team members to facilitate the payer coverage process and drive holistic patient support.
• Manage the reimbursement process by supporting all involved in the coverage process, including prescriber office staff, specialty pharmacies and patients and/or their care givers.
• Manage the reimbursement and support requests for hub patient enrollments in a specific geography and serve as the primary point of contact for the healthcare providers, patients and Client’s Account Managers in that area.
• Perform benefit verification and coverage determination to identify and communicate the patient’s plan benefit coverage, including the need for prior authorization, appeal, tier exception, and/or formulary exclusions.
• Support the facilitation of prior authorization and appeal processes by gathering necessary clinical documentation and information, with guidance from senior team members as needed.
• Screen, enroll, and educate eligible patients of free goods programs where applicable as per program rules.
• Perform patient outreach as needed to facilitate prescription fulfillment and therapy adherence as per program rules.
• Comprehensively understand the benefits investigation process, insurance plans, and available patient assistance programs.
• Operate both inbound and outbound calls per program-approved FAQs, guides, scripts, and other program-approved materials; field inbound calls from prescribers, patients and client’s account teams as directed by the program-approved FAQs.
• Inform and support patients by providing education and information throughout their therapy journey regarding the status of their medication, needed processes, and connections to other stakeholders providing support like their Oncology treatment care team or pharmacy.
• Assist in monitoring and maintaining the reauthorization of insurance coverage to ensure continuity of therapy access.
• Serve as primary point of contact for incoming calls from patients, caregivers, physicians and client’s department teams. Proactively provide updates to internal and external stakeholders on patient cases in a timely manner.
• Create trusting relationships with physician offices and client department teams in their assigned region(s).
• Conduct scripted welcome calls and ongoing educational support calls to patients and office staff to introduce the program and confirm enrollment information as necessary.
• Demonstrate an understanding of business rules, work instructions, and company-approved communications for patients and HCPs. Comprehensively understand the benefits investigation process, plan design, prior authorization criteria and processes, and all available patient support program offerings.
• Navigate operating platform with ease. Document and meticulously note in each patient’s profile regarding updates and aspects of the patient’s journey.
• Use discretion and independent judgment in handling customer complaints, while documenting and forwarding to appropriate team members.
• Communicate with Directors, Team Leads, Supervisor and Program Manager on noteworthy program updates or obstacles.
• Communicate with specialty pharmacies…