Regional Case Manager - Long Term Care Job at RareMed Solutions
**Remote Work Flexibility**
Purpose:
The Regional Case Manager – Long Term Care (RCM-LTC) is a professional client facing role responsible for various functions, including accurate and timely response to client inquiries regarding patient-specific programs, referral status or escalation, benefits verification, and financial assistance counseling. The RCM-LTC acts as a single point of contact for communication and coordination among all participants of the LTC facility health care team to ensure that the services are provided. The RCM-LTC will manage the benefits investigation process for to determine patient eligibility and coverage per their plan. They will also be responsible for providing professional, concise internal and external communication regarding case status updates, next steps in prescription processing, and communication of reimbursement issues. The RCM-LTC oversees the provision of extended, ongoing services to residents of long-term care facilities. Also, provides intensive case management in a collaborative process that includes therapy initiation, referrals to Specialty Distributors, and triages to Specialty Pharmacy or Long-Term Care Pharmacies.
Responsibilities:
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Serve as the point of contact for regionally aligned field team related to cases identified as LTC to initiate and support therapy to residents of long-term care facilities.
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Coordinate all LTC facility-related support and access services across all functions including patient support, benefits verification and triage to specialty pharmacy.
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Review and add LTC profile data to capture the key information related to LTC facilities and customers.
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Maintain frequent touchpoints through outreach to LTC providers and patients/caregivers to communicate progress throughout their journey.
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Work independently to complete assigned work in accordance with Standard Operating Procedures and defined service levels to complete Service requests, program enrollment, answer inquiries, coordinate investigation and determination of patient benefits coordinate access to free Supply Program, if applicable.
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Independently and effectively identify adverse events and/or product complaints and triage as appropriate.
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Apply defined business rules to qualify patients for manufacturer supported programs.
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Interact and coordinate with internal program operations, including reimbursement, and program management to ensure provider and patient needs are met in addition to attending any regularly scheduled calls.
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Provide support, education, and status updates to regionally aligned field teams, LTC facility staff, patients and caregivers to ensure efficient referral processing, triaging, and shipment set ups.
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Manage assigned territory using problem solving skills and professional judgement to independently make sound decisions for timely case resolution.
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Ability to coordinate and collaborate with manufacturer representatives, LTC facilities and other key personnel on complex cases which require strategic intervention.
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Independently and effectively resolves complex issues with creativity and innovation while maintaining compliance.
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Refer patients to third-party or other foundation programs per program business rules.
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Manage case triage to Specialty Pharmacy or Long-Term Care Pharmacy, if applicable, and ensure proper information has been communicated to the Specialty Pharmacy Liaison.
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Collaborate with SPs and field teams on case recovery efforts.
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Process PAP requests, when applicable per program business rules, in a timely fashion and PAP re-approval verification for continued eligibility.
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Demonstrate the ability to prioritize and balance the needs of patients, LTC facility staff and rare disease clients utilizing program business rules.
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Provide concierge-level service to internal and external customers; resolve any customer and client requests in a timely and accurate manner; escalate appropriately.
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Maintain frequent phone/email contact with internal operational staff, external client, external specialty pharmacies, providers, and payers. Utilizes outbound faxes, email alerts, and mailings per program guidelines.
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Strong compliance mindset, demonstrating clear understanding of patient privacy laws.
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Actively participate in building and maintaining respectful, collaborative team relationships, exercising, and encouraging positivity.
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Other duties as assigned including cross training to support all Regional Patient Case Manager activities when needed.
Required Qualifications:
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High school diploma plus 2+ years recent case management experience
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Previous 3+ years of experience in a pharmacy, healthcare setting, and/or insurance background preferably in long term care reimbursement or disability care
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Advanced knowledge and experience in healthcare setting
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Strong interpersonal skills; ability to communicate effectively both orally and in writing with a focus on customer satisfaction
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Empathy, drive and commitment to exceptional service
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Ability to build productive internal/external working relationships
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Ability to independently manage case load, prioritize work, and use time management skills to meet deliverables
Preferred Qualifications:
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Undergraduate degree and/or equivalent work experience
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Certified Pharmacy Technician (CPhT) or Case Management Experience
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Long-term care reimbursement/case management experience is a major plus
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Bilingual Spanish speaking and writing is plus
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Strong analytical and organizational skills with meticulous attention to detail
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Experience with benefit investigation and verification of prescription benefits
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Working knowledge of Third-Party and other Foundation programs a major plus
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Understanding of plan types – Government, Commercial, Medicaid, VA, Fed
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Knowledge of insurance structure (ex PBM’s, major medical plans, co-pay assistance /cards)
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Ability to proficiently use Microsoft Excel, Outlook, and Word
Work Environment
This job operates in a professional office environment and teleworking from the employee’s home address listed in their employment file. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines. When telecommuting employees must have reliable internet access in order to access required systems and software associated with the position's responsibilities. The amount of time the employee is expected to work per day or pay period will not change as a result of participation in the teleworking program. Employees are responsible for the set-up of their home office environment, including physical set-up, internet connection, phone line, electricity, good lighting, comfortable temperature, furniture, etc. Employee’s teleworking space should be separate and distinct from their “home space” and allow for privacy. RareMed expects employees teleworking to be as efficient and professional as if they were in the office. The amount of time spent in office or teleworking is contingent upon the needs/priorities of RareMed and will vary based on those needs/priorities.
Physical Demands
While performing the duties of this job, the employee is regularly required to talk or hear. The employee frequently is required to stand; walk; use hands and fingers, handle or feel; and reach with hands and arms.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function of the job.
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