Job Title: Case Manager
Duration: Contract
Location: 7000 Park Ln, PB2, Pittsburgh, PA 15275
Shift Type: 8:30am-5pm
Job Duties:
• Takes the lead in managing the Care Coordination process within an assigned territory. Uses tact and independent judgment to balance patient and physician needs with the business realities and necessities of the program. Establishes and maintains professional and effective relationships with all internal and external customers (i.e., care coordination colleagues, care field team, patient advocacy groups, insurance company case managers, specialty pharmacies, physician office staff, and office coordinators) while multitasking to coordinate, evaluate and advocate for options and services to meet the client’s needs.
• Assesses physicians’ needs and develops action plans that proactively mitigate delays in therapy. Coordinates exchanging all patient-related information with internal and external customers (i.e., patients, families, healthcare providers, insurance companies, and specialty pharmacies). Effectively manages the database, including data on each individual, their insurance, coverage approvals, ongoing coverage requirements, and all patient and provider interactions.
• Keeps up to date with reimbursement process, billing/coding nuances, insurance plans, payer trends, financial assistance programs, charitable access, related resources, regional level, and alternative resources.
• Assists in obtaining insurance approvals/denials and/or appeals for therapy. Assists patients and HCPs with processing Copay Assistance/Reimbursement and Patient Assistance Programs applications. Helps with ordering/triaging prescriptions for patients or HCPs.
• Provides education to patients and health care providers regarding insurance requirements, options, and limitations necessary to initiate therapy. Provides education on relevant disease/product information.
• Exhibits a leadership role by demonstrating accountability for action plan execution and energetically drives for success and results. Supports special projects as requested. (i.e., patients, families, healthcare providers, insurance companies, and specialty pharmacies).
• Identifies and recommends process improvements to support operational efficiencies. Effectively shares knowledge with other team members through orientation training, case studies, and consultation for complex cases.
Skills:
• Bachelor’s Degree (or equivalent) in a related area focusing on Health Care, Social Work, or Nursing, preferred.
• Minimum 3 years of recent experience in the case management process preferred. Proven ability to assess the ethics and legality of patient’s care
• Experience in 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 professionally and courteously. Mediation and problem-solving skills. The 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
• Must possess the ConnectiveRx core values of Passion, Innovation, Integrity, and Accountabilit y
Education/Certification Required:
• Bachelor’s Degree (or equivalent) in a related area focusing on Health Care, Social Work, or Nursing, preferred.
...About Side Side (formerly PTW) is a global video game development and services provider, offering technical and creative solutions to many of the largest developers and studios around the world. Founded in 2009 and drawing on 30+ years' experience from our parent...
The License and Credentialing Specialist is an individual who is highly organized and detail-oriented.If your skills, experience, and qualifications match those in this job overview, do not delay your application.Their focus is maintaining compliance with regulatory...
...Faculty, Music Theory and Composition Austin Community College Job Posting Closing Times: Job postings are removed from advertising at 12:00 A.M. on the closing date e.g., at midnight on the day before the closing date. Austin Community College employees are...
...Job Description Pickup and delivery of cargo to and from various destinations usually within proximity of the consolidation/distribution center. The loading and unloading of trailers utilizing the same techniques, technology and procedures as a dock worker. Actual...
...immediately for their Mansfield, PA location. Job requires: Someone that can works in a team environment. Pay based on experience. Safely assist in Cleaning pits, frac tanks, gas busters, and well site locations. Safely handle equipment. Ensures work...