Case Manager in Helena, Montana

• Notify patients, physicians, practitioners, and or clinics of any financial responsibility of services provided as applicable

• Assess patient’s financial ability to afford therapy and provide hand on guidance to appropriate financial assistance

• Follow through on all benefit investigation rejections, including Prior Authorizations, Appeals, etc. All avenues to obtain coverage for the product must be fully exhausted

• Track any payer/plan issues and report any changes, updates, or trends to management

• Search insurance options and explain various programs to the patient while helping them to select the best coverage option for their situation

• Handle all escalations based upon region and ensure proper communication of the resolution within required time frame agreed upon by the client

• Serve as a liaison between client sales force and applicable party

• Mediate situations in which parties are in disagreement and facilitate a positive outcome

• Concurrently handle multiple outstanding issues and ensure all items are resolved in a timely manner to the satisfaction of all parties

• Responsible for reporting any payer issues by region with the appropriate team

• As needed conduct research associated with issues regarding the payer, physician’s office, and pharmacy to resolve issues swiftly

What is expected of you and others at this level

• Effectively applies knowledge of job and company policies and procedures to complete a variety of assignments

• In-depth knowledge in technical or specialty area

• Applies advanced skills to resolve complex problems independently

• May modify process to resolve situations

• Works independently within established procedures; may receive general guidance on new assignments