USA-Case Manager I (Clinical) - eTeam Inc.
Cambridge, MA 02141
About the Job
Job title:- Case Manager
Location:- Cambridge, MA 02141 (Hybrid role 03 days onsite 02 days remote)
Duration:- 12 Months
This is an 10am-6:30pm EST schedule
Description:
Job Purpose:
Location:- Cambridge, MA 02141 (Hybrid role 03 days onsite 02 days remote)
Duration:- 12 Months
This is an 10am-6:30pm EST schedule
Description:
Job Purpose:
- Apply care coordination and case management expertise by supporting patients/families and collaboration team with services to address patient barriers to treatment.
- Coordinate between patients/families, healthcare providers, insurance providers, specialty pharmacy and local resources.
- Conduct benefit investigations, provide patient education, enroll/educate patients on/with patient support programs and coordinate outpatient services. Exceed best-in-class patient services to ensure a positive patient experience to support Client business priorities.
Job Responsibilities:
- Engage patients/families to create a trusting relationship, uncover patient needs, understand challenges, and provide education and support. Manage complex issues and utilize approved resources to reduce/remove barriers as needed
- Leads the case management process, while balancing the needs of individual patients to align with the business needs/objectives of Client and the Rare Blood Disorder business unit.
- Assess patients’ needs to provide for the initiation and continuation of treatment while coordinating the exchange of patient-related information to the appropriate internal and external stakeholders.
- Conduct benefit investigations and secure insurance approval for therapy, proactively plans for maintenance of coverage by working with the patients/families, healthcare providers, insurance companies and specialty pharmacies.
- Maintains comprehensive understanding of the reimbursement process, navigation of health care systems, insurance plans, payer trends, and internal and external patient assistance programs and related resources.
- Enroll patients who qualify into the appropriate financial assistance program as needed/required.
- Educates patients, family members, healthcare providers, and other collaboration members regarding insurance options, limitations, and other requirements. Also educate all stakeholders on patient support services.
- Exhibits a leadership role within the cross-functional regional team. Able to consistently identify complex patient specific issues and develop a plan to address accordingly. Establish and maintains professional and effective relationships with all internal and external stakeholders including but not limited to case management colleagues, medical, sales, market access, insurance companies, specialty pharmacies, infusion site staff and office coordinators.
- Raises own performance expectations and goals to support entrepreneurial approach to the business.
- Demonstrates and maintain high level of business acumen, understanding of Client business model and the role of the case manager and patient support services team in driving initiatives to meet the goals of the business unit.
- Document call details with attention to data integrity to ensure compliance and enhance our service offering
- Leverages CRM reporting tools and data analytics to make strategic decisions about their territory and prioritize patient and customer needs.
- Provide caseload coverage outside of assigned territory as needed.
- Seek coaching feedback to enhance service skills
- Ensure compliance with Client policies
Qualifications:
Bachelor’s degree required
- Degree in social work or human services preferred (or equivalent professional experience in a health care or insurance setting.
- Minimum 4-6 years of experience in a patient facing or case management role. Experience should include but is not limited to home care management, case management review, utilization review, social service support, insurance reimbursement and patient advocacy.
- Industry experience preferred.
- In-depth understanding of health insurance benefits, relevant state and federal laws and insurance regulations.
- Developed communication, mediation, and problem solving-skills
- Experience with engaging patients and caregivers with rare/chronic conditions
- Ability to identify and handle sensitive issues with opposing opinions, work independently and lead projects as needed.
- Excellent attention to detail and ability to multi-task in a fast-paced environment
- Experience with Salesforce CRM preferred
- Proficient with MS Word, MS Excel, and MS PowerPoint
- Working hours may vary based on business needs and team coverage
- Spanish language fluency highly preferred
Source : eTeam Inc.
