Case Manager

4 weeks ago

Chesterfield, United States EVERSANA Company Full time
Company Description

At EVERSANA, we are proud to be certified as a Great Place to Work across the globe. We're fueled by our vision to create a healthier world. How? Our global team of more than 7,000 employees is committed to creating and delivering next-generation commercialization services to the life sciences industry. We are grounded in our cultural beliefs and serve more than 650 clients ranging from innovative biotech start-ups to established pharmaceutical companies. Our products, services and solutions help bring innovative therapies to market and support the patients who depend on them. Our jobs, skills and talents are unique, but together we make an impact every day. Join us

Across our growing organization, we embrace diversity in backgrounds and experiences. Improving patient lives around the world is a priority, and we need people from all backgrounds and swaths of life to help build the future of the healthcare and the life sciences industry. We believe our people make all the difference in cultivating an inclusive culture that embraces our cultural beliefs. We are deliberate and self-reflective about the kind of team and culture we are building. We look for team members that are not only strong in their own aptitudes but also who care deeply about EVERSANA, our people, clients and most importantly, the patients we serve. We are EVERSANA.

Job Description

The Case Manager / Patient Support Navigator is a vital part of the front-line patient and caregiver support. The CM-PSN acts as a Social Determinants of Health (SDOH) resource for patients and family members throughout their patient assistance journey. The CM-PSN provides patient-centered support, acts as liaison between patients, caregivers, medical professionals, internal and external matrix partners.

ESSENTIAL DUTIES AND RESPONSIBILITIES:
Our employees are tasked with delivering excellent business results through the efforts of their teams. These results are achieved by:
  • Assist patients/caregivers as appropriate to function as a patient advocate, educator, and single point of contact for patients, and caregivers.
  • Field incoming phone calls from patients, caregivers, and providers; triage calls and route to the appropriate team for further action if applicable.
  • Provide scripted information on how patients can access reliable sources of information through various resources available.
  • Assess patient's needs upon initial welcome call and through navigation, matching the patient's needs with appropriate resources and support within program offerings.
  • Provide newly registered patients with a welcome call including patient support materials and resources.
  • Adhere to all appropriate compliance standards outlined in business rules, policies, and SOPs.
  • Assess patient barriers based on SDOH which include factors such as, but not limited to, socioeconomic status, education, housing, transportation, food, physical environment, employment, and social support networks, as well as access to health care. Refer patients to aligned resources within program service offerings.
  • Identify patients closest SDOH resource outlet and assist in scheduling to obtain available resources.
  • Receive incoming data related to patient support programs such as enrollment forms, insurance cards for benefits investigations for review, save related documents within the patient database, triage, and route data to the appropriate department or team member as applicable.
  • Conduct benefit investigation and prior authorization with payers.
  • Provide updates and partner with all team members to ensure patients are served in a timely manner.
  • Participate and support multiple ongoing department projects.
  • Ensure patient centered excellence in supporting all internal and external stakeholders involved in the patient journey.
  • Other tasks and projects as assigned client inquiries, exceptions, management mailbox, reconciliation reports, and workforce functions.
  • All other duties as assigned.
Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions of this position.

EXPECTATIONS OF THE JOB:

Job Duties
  • Learn, understand, and follow all company and client policies and procedures.
  • Accept being accountable and responsible in work practices and expectations. Delivers what is promised.
  • Foster a collaborative, team-oriented attitude. Communicates effectively with others with clarity and transparency.
  • Use innovative critical and creative thinking to evaluate and solve work and customer issues.
  • Seek assistance in solving work problems through collaboration and information seeking.
Personal Accountability
  • Attendance - Excellent attendance is a key success driver for this role
  • Compliance Wire Online Training - at least 90% on-time completion
  • Professional, positive, ethical, and responsible behavior
  • Collaboration, proactive, and effective communication
  • Ability to self-manage, multitask and problem solve
  • Proficient computer skills
  • Demonstrate cultural beliefs
  • Agents who regularly perform at or above the targeted performance levels will be eligible for remote work opportunities with the following considerations
    • Supervisor approval
    • Proof of HIPAA compliant workspace
    • Proof of secure internet connectivity with sufficient bandwidth to successfully conduct the role activities
    • Maintain in office performance & quality levels and schedule adherence
    • Agree to and sign the Hybrid Remote Work policy
The above list reflects the general details necessary to describe the expectations of the position and is not to be construed as the only expectations that may be assigned for the position.

An individual in this position must be able to successfully perform the expectations listed above.

Qualifications

The requirements listed below are representative of the experience, education, knowledge, skill and/or abilities required.
  • Education Bachelor's Degree and 5 years' experience in healthcare practice management or patient services setting.
  • Technology/Equipment Strong computer skills with a working knowledge of Microsoft Word, Excel, and PowerPoint.
  • Soft Skills Excellent oral, written, and interpersonal communication skills. Ability to multi-task. Ability to work independently and function as a team player. Ability to work in a fast paced, metric driven environment, while remaining patient minded. Ability to clearly and consistently demonstrate compassion and empathy.
PREFERRED QUALIFICATIONS:
  • Experience Patient support and access with call center experience. Patient assistance, reimbursement and/or oncology experience. Medical coding, coverage, policy, and payment experience strongly preferred.


Additional Information

OUR CULTURAL BELIEFS

Patient Minded I act with the patient's best interest in mind.

Client Delight I own every client experience and its impact on results.

Take Action I am empowered and hold myself accountable.

Embrace Diversity I create an environment of awareness and respect.

Grow Talent I own my development and invest in the development of others.

Win Together I passionately connect with anyone, anywhere, anytime to achieve results.

Communication Matters I speak up to create transparent, thoughtful, and timely dialogue.

Own It I hold myself and others accountable for results.

From EVERSANA's inception, Diversity, Equity & Inclusion have always been key to our success. We are an Equal Opportunity Employer, and our employees are people with different strengths, experiences, and backgrounds who share a passion for improving the lives of patients and leading innovation within the healthcare industry. Diversity not only includes race and gender identity, but also age, disability status, veteran status, sexual orientation, religion, and many other parts of one's identity. All of our employees' points of view are key to our success, and inclusion is everyone's responsibility.

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