Job description

ConnectiveRx is looking for Case Managers to join our team in Robinson Township (near Target). The Case Manager will be responsible for handling customer concerns through research and communication with involved departments / Service Level Agreements and client products. Partner with internal and external departments and staff to achieve resolution for concerns. Manage database for cases. Responsible for timely case resolution and maintaining compliance. Exhibit a high level of case management expertise and demonstrated leadership skills. Utilize care coordination to address patient and physician concerns; obtain insurance approval for designated therapy and proactively plan to avoid the potential of delayed coverage by working with the patient, family, insurance company, physicians, workplace benefits administrators and persons from other areas. Facilitate the case management process along the healthcare continuum.

Essential Functions:

• Manages the Care Coordination process within an assigned territory while balancing the needs of individual patients and physicians with the business realities and necessities of the program.

• Assesses physicians’ needs and develops action plans that provide for the introduction of therapy while coordinating the exchange of all patient-related information with internal and external customers

• Maintains comprehensive understanding of the reimbursement process, billing/coding nuances, insurance plans, payer trends, financial assistance programs, charitable access, and related resources

• Assists in obtaining insurance approval for therapy, and proactively plans to mitigate delays in coverage by working with the patients and their family, healthcare providers, insurance companies, and specialty pharmacies.

• Maintains up-to-date knowledge of the resources available at the regional level, including alternative resources, and applies this knowledge in way that best supports patient care

• Educates patients, family members, health care providers, and others regarding insurance options and limitations, insurance requirements necessary to initiate therapy, case management services and relevant disease/product information as necessary.

• Exhibits a leadership role within the assigned territory. Able to consistently identify complex patient specific issues and develop action plans accordingly. Demonstrates accountability for action plan execution, and energetically drives for success and results

• Establishes and maintains professional and effective relationships with all internal and external customers including but not limited to care coordination colleagues, Patient Advocacy Groups, insurance company case managers, specialty pharmacies, physician office staff and office coordinators.

• Raises own performance expectations and goals to support entrepreneurial approach to the business

• Consistently monitors systems and processes and recognizes when it is time to try new approaches

• Effectively shares reimbursement and other knowledge with patient care team members through orientation training, case studies, consultation for complex cases and special projects as requested.

• Consistently maintains accurate data on each individual, their insurance, coverage approvals, on-going coverage requirements and all patient and provider interactions. Coordination of information with all customers is required.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function(s).

Qualifications:

• Bachelor’s Degree (or equivalent) in related area with focus in Health Care, Social Work, Nursing, preferred.

• Minimum of 3 years recent experience in the case management process, preferred.

• Experience in a combination of home care management, case management review, utilization review, social service support, insurance reimbursement and patient advocacy, preferred.

• Related industry experience, preferred.

• In-depth understanding of health insurance benefits, relevant state and federal laws and insurance regulations, highly desired.

• Developed communication, mediation, and problem solving skills.

• Experience with data entry/computer literate skills, preferred.

• Ability to identify and handle sensitive issues with opposing opinions, work independently and handle projects or multiple tasks.

• Spanish speaking skills a plus.

Job Type: Full-time

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Flexible schedule
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Referral program
• Retirement plan
• Tuition reimbursement
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday

Supplemental pay types:

• Bonus pay

COVID-19 considerations:
We're taking all necessary precautions to ensure the safety of our employees.

Ability to commute/relocate:

• Pittsburgh, PA 15275: Reliably commute or planning to relocate before starting work (Preferred)

Education:

• High school or equivalent (Required)

Experience:

• Case management: 1 year (Preferred)

Work Location: One location

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