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Case Manager I
Ref No.: 18-02815
Location: South San Francisco, California
Duties:
  • The Case Manager acts as a liaison between patients, providers, MDs, distributors, and insurance carrier to assure services are provided in the least restrictive and least costly manner.
  • Provides customer focused reimbursement support to patients, pharmacists, physicians and internal sales force
  • Provides Cross-Functional/Project Support/Participation; Personal Development Support.
  • Educates, informs and assists patients and providers to navigate through the reimbursement process for the assigned product
  • Identifies barriers to reimbursement and continually identifies and recommends program efficiencies to the Supervisor to promote a high quality of work by Access Solutions/GATCF staff
  • Identifies and facilitates referrals to alternative coverage options and financial assistance programs for patients who are underinsured or require copy assistance
  • Establishes relationships with appropriate stakeholders including internal & external partners
  • May conduct necessary benefits, coverage and payer research/investigations to ensure appropriate resources, compliance with payer appeal policies, practices, timelines
  • Educates, informs and generally assists patients and their families, as well as other related external or internal parties on how to navigate the appeals process
  • This position may require some travel and flexibility in the work shift.
  • Required to work overtime as assigned during periods of peak business needs

Skills:
  • The successful candidate will demonstrate the following competencies critical to this role:
  • Communication – Listens well; expresses ideas fluently and logically; is open to input and can be depended on for truthfulness
  • Inspiring and Influencing – Fosters an exchange of ideas and support; persuades and influences without authority
  • Teamwork and Collaboration – Creates the atmosphere of openness and trust' collaborates; offers support and encouragement
  • Achieving Results – Is goal-directed and persistent; is accountable for meeting commitments; recognizes the contributions of peers
Qualifications:
  • Bachelors degree is preferred
  • A minimum of 3 years of reimbursement experience preferred
  • Proficient in all aspects of reimbursement (i.e., benefit investigations, payer reimbursement policies, regulatory and administrative rules.
  • Understands reimbursement/funding resources and how to access these resources.
  • Demonstrates effective problem-solving skills and provides excellent customer service.
  • Excellent investigational and analytical skills with a proven ability to communicate effectively in both written and verbal format.
  • Ability to work collaboratively in a team structure and responsibly delegates next steps to appropriate team members.
  • Must be able to work effectively under pressure and prioritize tasks.
  • Must be able to follow written Standard Operating Procedure
  • Candidate must have excellent knowledge of the managed care industry, including government payers.

Education:
Bachelor's degree preferred