Practice Group Manager providing leadership and support to mental health teams in Georgia. Managing office operations to enhance clinician and patient satisfaction and financial performance.
About the role
- Regional Patient Case Manager provides support for long-term care residents and manages communications with healthcare professionals. This role involves multiple responsibilities across facilities and coordination efforts.
Responsibilities
- 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
- Coordinate all LTC facility-related support and access services across all functions but not limited to: support on patient journey calls, benefits verification, prior authorization and appeals, triage to specialty pharmacy or Long-Term Care Pharmacies, and any necessary follow ups
- Maintain clear, concise, and accurate documentation on all accounts according to Standard Operating Procedures
- Review and add LTC profile data to capture the key information related to LTC facilities and customers
- Conduct initial welcome calls to LTC facility-designated champions and/or patients/caregivers informing them of available services as well as future targeted outreach to provide ongoing support
- Maintain frequent touchpoints through outreach to LTC providers and patients/caregivers to communicate progress throughout their journey
- Work independently to complete assigned work in accordance with Standard Operating Procedures and defined service levels to complete program enrollment, answer inquiries, and coordinate access to free 14-Day Supply Program, if applicable
- Independently and effectively identify adverse events and/or product complaints to document and triage as appropriate
- Apply defined business rules to qualify patients for manufacturer supported programs
- 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
- 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
- Manage assigned territory using problem solving skills and professional judgement to independently make sound decisions for timely case resolution
- Ability to coordinate and collaborate with manufacturer representatives, LTC facilities and other key personnel on complex cases which require strategic intervention
- Independently and effectively resolves complex issues with creativity and innovation while maintaining compliance
- Refer patients to third-party or other foundation programs per program business rules
- 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
- Collaborate with Long Term Care Pharmacies and field teams on account progression and case recovery efforts and provide relevant case status details and updates
- Process PAP requests, when applicable per program business rules, in a timely fashion and PAP re-approval verification for continued eligibility
- Demonstrate the ability to prioritize and balance the needs of patients, LTC facility staff and rare disease clients utilizing program business rules
- Provide concierge-level service to internal and external customers; resolve any customer and client requests in a timely and accurate manner; escalate appropriately
- 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
- Strong compliance mindset, demonstrating clear understanding of patient privacy laws
- Actively participate in building and maintaining respectful, collaborative team relationships, exercising, and encouraging positivity
- Other duties as assigned including cross training to support all Regional Patient Case Manager activities when needed
Requirements
- High school diploma plus 2+ years recent case management experience
- Previous 3+ years of experience in a pharmacy, healthcare setting, and/or insurance background preferably in long term care reimbursement or disability care
- Advanced knowledge and experience in healthcare setting
- Strong interpersonal skills; ability to communicate effectively both orally and in writing with a focus on customer satisfaction
- Empathy, drive and commitment to exceptional service
- Ability to build productive internal/external working relationships
- Ability to independently manage case load, prioritize work, and use time management skills to meet deliverables
Benefits
- Hybrid work structure, combining remote work and in-office requirements
- Must be within commuting distance to Pittsburgh, PA
- Flexible scheduling
Job title
Job type
Experience level
Salary
Not specified
Degree requirement
Location requirements
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