Executive Case Manager; Remote

Location: Jeffersonville, IN

Remote Status: Remote

Job : 776

Valeris is a fully integrated life sciences commercialization partner that provides comprehensive solutions that span the entire healthcare value chain. Valeris works on behalf of life sciences companies to improve the patient experience so that patients can access and adhere to critical medications. The company is headquartered in Morrisville, North Carolina and Jeffersonville, Indiana. To learn more about Valeris, please visit

A typical day in this role will include ownership of your patient journey from initiation to closure by using your critical thinking skills and your knowledge of the program and industry rules and standards. This includes completing benefit investigations, tracking prior authorizations / denial appeals, and assisting patients or other callers/stakeholders through resolution (via email, inbound/outbound calls and using our Lynk technology).

This role requires a strong understanding of pharmacy and medical billing and coding, excellent communication skills, and the ability to navigate complex reimbursement processes.

• Relationship Management
  • Builds trusted relationships with patients, prescribers, and appropriate client stakeholders regarding reimbursement inquiries and challenges through proactive communication, timely and accurate execution of deliverables and demonstrated relentless passion for helping patients.
• Manages all relationships in a manner that adheres to all relevant laws, regulations, program-specific operating procedures and industry standards related to access and affordability, including HIPAA and insurance guidelines.
  • Managed through call/contact center structure, this role supports inbound and outbound calls to patients, caregivers, specialty pharmacies and healthcare professionals.
  • Performs post Benefits Investigation calls to patients and/or physicians explaining coverage options and next steps in the access journey.
  • Manages all client inquiries as appropriate, such as case specific statuses.
  • Manages HCP inquiries, as applicable, pursuant to business rules.
• All communications with the client’s field teams will remain compliant and adhere to ways of working protocols outlined between Pharma Cord and the client teams. Inbound Call Management
  • Manages inbound calls as directed by the program-approved FAQs
  • Triage patients to internal or external resources as appropriate.
• Personalized Case Management
  • Provides personalized case management to patients and HCPs including outbound communication to HCPs, specialty pharmacies and patients to communicate benefit coverage and/or appropriately help drive next steps in obtaining coverage and/or access to prescribed medicine. All communications for case management will follow the guidelines set forth for the program and only provide information publicly available and/or outlined in the patient insert.
  • Leverages electronic tools to identify benefits and payer coverage; completes manual benefit investigation as needed.
  • Identifies and communicates patient’s plan benefit coverage including the need for prior authorization, appeal, tier exception, and/or formulary exclusions.
  • Serves as a subject matter expert to internal team as required and appropriate.
  • Uses electronic resources to obtain benefit coverage outcome and if needed, outbound call to payers and HCPs to follow up on proper submission and/or outcome.
  • Coordinates nurse teach with nurse educators, as applicable to program.
  • Supports adherence services as applicable to program.
  • Identifies peer support resources for patients.
  • Proactively communicates needs for reverification of prior authorization or re-enrollment.
  • Identifies and reports adverse events, product complaints, special situation reports and/or medical inquiries received in accordance with program operating procedures and the Business Rules.
  • Documents all activities within the Pharma Cord Lynk system, maintaining detailed records of reimbursement activities, including claims status, payments, and appeals.
  • Generate reports and analysis as needed to identify trends and opportunities for improvement in accordance with business requirements.
  • Ut…