Clinical Services Manager role at DaVita, supporting clinics with safety and regulatory oversight through targeted coaching and quality initiatives. Ensuring compliance and addressing performance goals with teams.
About the role
- Virtual Access and Reimbursement Manager providing education to healthcare providers on patient benefits and access. Engaging with HCPs to ensure successful reimbursement processes within specialty pharmacy networks.
Responsibilities
- Engage healthcare providers and appropriate office staff to educate on access to prescribed treatments within the specialty pharmacy and HUB channel, including addressing questions about initial access, insurance approval and reauthorizations pertaining to the initiation of product.
- Educate HCP office staff about prior authorization & appeals process, how to access related forms, and high-level information about submission procedures and reauthorization requirements.
- Work compliantly and proactively to identify and resolve patient access and reimbursement issues, within assigned geography.
- Assigned geography may be adjusted based on zone and national volume.
- Provide appropriate factual process information to HCP office utilizing Personal Health Information (PHI), with appropriate patient consent.
- Serve as reimbursement expert for patient support services team for assigned geography/plans.
- Utilize approved resources and call guides/FAQs to provide education and answer questions as needed.
- Conduct ongoing payer policy reviews and contribute local, regional and national policy insights to Field Access Managers and client leadership.
- Virtually manage assigned accounts and align with Field Access and Reimbursement team, sales teams as well as specialty pharmacy and HUB team on ongoing support needs.
- Document call details with attention to data integrity to ensure compliance with program policies and business rules.
- Navigate CRM platform in daily interactions and learn internal team processes (when available).
- Maintain confidentiality of Patient Health Information (PHI) and act in compliance with all laws, regulations, and company policies.
- Triage appropriate escalations to the Field Access Manager team in accordance with the program design and business rules.
- Comply, take, and attend all required training.
- Adhere to all Inizio and client policies, procedures, business rules, and call guides, as well as applicable laws.
Requirements
- BS/BA Degree Required
- Proven success operating in a virtual environment
- 3+ years of relevant experience in – reimbursement and patient access, market access, specialty pharmacy, or physician/system account management.
- Experience engaging HCP staff in a support role to educate on access pathways and product requirements.
- Experience navigating payer reimbursement process for oral medications.
- Experience with specialty products acquired through specialty pharmacy networks.
- Patient-centric and service-oriented mindset, with a high degree of emotional intelligence and empathy.
- Exceptional customer and patient engagement skills, attention to detail, and the ability to think comprehensively is a must.
- Exemplary interpersonal and listening skills.
- Strong communication (written and verbal), and presentation skills.
- High enthusiasm with a drive to success within a team – demonstrated ability to reach common goals in collaboration with multiple therapeutic specialists, sales leadership, market access, and patient support services colleagues.
- Highly organized with excellent attention to detail and the ability to multi-task in engaging both patients and providers.
Benefits
- Competitive compensation
- Excellent Benefits – accrued time off, medical, dental, vision, 401k, disability & life insurance, paid maternity and bonding time benefits, employee discounts/promotions
- Generous performance-driven Incentive Compensation package
- Competitive environment with company wide recognition, contests, and coveted awards
- Exceptional company culture
- Recognized as a Top Workplace USA 2021
- Awarded a “Great Place to Work” award in 2022, 2023 & 2024
Job title
Job type
Experience level
Salary
Not specified
Degree requirement
Location requirements
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