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Case Manager I - Esbriet
Ref No.: 17-15082
Location: South San Francisco, California
Job Title: Case Manager
Job Company: Major BioPharma
Job Location: SSF, CA 94080
Job Duration: 6+ months contract
 
Job Description:
*** Periodic mandatory overtime is required ****

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
  • 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 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 under insured 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 work shift.
 
Desired 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 atmosphere of openness and truest’ collaborates; offers support and encouragement
  • Achieving Results – Is goal directed and persistent; is accountable for meeting commitments; recognizes the contributions of peers
Qualifications:
  • 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 or equivalent experience