Executive Case Manager

Valeris, Inc.; Jeffersonville (IN); Vor Ort; USD 60.000 - 90.000; Vollzeit

Benefits dieser Stelle

Medical insurance

Dental/Vision insurance

401(k) match

Paid time off

Paid holidays

Zusammenfassung

Valeris, Inc. is seeking an Executive Case Manager to advise on insurance coverage and reimbursement challenges affecting patients and healthcare providers. The role educates on access tools, supports patient and HCP decisions, and ensures compliant communication with client teams.

The position emphasizes benefits investigations, payor interactions, and personalized case management to improve access to prescribed medicines, in a HIPAA-compliant environment.

Qualifikationen

• Bachelor's degree (or higher) required or strongly preferred.
• Minimum two years of experience in healthcare access delivery or management preferred.
• 5–10 years in insurance reimbursement, patient access, direct patient care, or patient education may substitute for degree.
• Certifications such as PACS, CHES, or CCM are a plus.
• Strong understanding of medical terminology and insurance processes (ICD-10, CPT, HCPCS).
• Bi-lingual skills are a plus.

Aufgaben

• Builds trusted relationships with patients, prescribers, and clients regarding reimbursement inquiries and challenges.
• Educates on access and reimbursement tools and Payor processes.
• Manages inbound/outbound calls from patients, caregivers, and healthcare professionals.
• Performs benefits investigations and communicates coverage options and steps.
• Documents activities in the Lynk system and generates reports to identify trends.

Kenntnisse

Healthcare knowledge

Communication skills

HIPAA compliance

Prior authorization knowledge

Bi-lingual helpful

Relationship management

Ausbildung

Bachelor's degree or higher

Tools

PharmaCord Lynk system

Jobbeschreibung

Valeris is a fully integrated life sciences commercialization partner that provides comprehensive solutions that span the entire healthcare value chain. Formed by the merger of PharmaCord and Mercalis, Valeris™ revolutionizes the path from life sciences innovation to real-life impact to build a world in which every patient gets the care they need. Valeris works on behalf of life sciences companies to improve the patient experience so that patients can access and adhere to critical medications. Backed by proven industry expertise, a deep commitment to patient care, the latest technology, and exceptionally talented team members, Valeris provides the data and strategic insights, patient support services and healthcare provider engagement tools to help life sciences companies successfully commercialize new products. Valeris provides commercialization solutions to more than 500 life sciences customers and has provided access and affordability support to millions of patients. The company is headquartered in Morrisville, North Carolina and Jeffersonville, Indiana. To learn more about Valeris, please visit www.valeris.com.

SHIFT AVAILABLE IS M-F 9AM-6PM EST

The Executive Case Manager provides expertise on insurance coverage and common access and reimbursement challenges affecting patients, healthcare providers and clients. The Executive Case Manager responsibilities include education on the access and reimbursement support tools available from Valeris and participating program, advising HCPs and/or patients and caregivers on the benefits and program eligibility for a specific patient, and educating HCP offices on Payor processes and procedures.

Key Responsibilities

• Relationship Management
  • Builds trusted relationships with patients, prescribers, and appropriate client stakeholders regarding reimbursement inquiries and challenges through proactive communication, timely and accurate execution of deliverables and demonstrated relentless passion for helping patients.
• Manages all relationships in a manner that adheres to all relevant laws, regulations, program-specific operating procedures and industry standards related to access and affordability, including HIPAA and insurance guidelines.
  • Managed through call/contact center structure, this role supports inbound and outbound calls to patients, caregivers, specialty pharmacies and healthcare professionals.
  • Performs post Benefits Investigation calls to patients and/or physicians explaining coverage options and next steps in the access journey. Manages all client inquiries as appropriate, such as case specific statuses. Manages HCP inquiries, as applicable, pursuant to business rules. All communications with the client’s field teams will remain compliant and adhere to ways of working protocols outlined between Valeris and the client teams.
• Inbound Call Management
  • Manages inbound calls as directed by the program-approved FAQs Triage patients to internal or external resources as appropriate.
• Personalized Case Management
  • Provides personalized case management to patients and HCPs including outbound communication to HCPs, specialty pharmacies and patients to communicate benefit coverage and/or appropriately help drive next steps in obtaining coverage and/or access to prescribed medicine. All communications for case management will follow the guidelines set forth for the program and only provide information publicly available and/or outlined in the patient insert.
  • Leverages electronic tools to identify benefits and payer coverage; completes manual benefit investigation as needed. Identifies and communicates patient’s plan benefit coverage including the need for prior authorization, appeal, tier exception, and/or formulary exclusions.
  • Serves as a subject matter expert to internal team as required and appropriate.
  • Uses electronic resources to obtain benefit coverage outcome and if needed, outbound call to payers and HCPs to follow up on proper submission and/or outcome.
  • Coordinates nurse teach with nurse educators, as applicable to program.
  • Supports adherence services as applicable to program.
  • Identifies peer support resources for patients.
  • Proactively communicates needs for reverification of prior authorization or re-enrollment.
  • Identifies and reports adverse events, product complaints, special situation reports and/or medical inquiries received in accordance with program operating procedures and the Business Rules.
  • Documents all activities within the PharmaCord Lynk system, maintaining detailed records of reimbursement activities, including claims status, payments, and appeals.
  • Generate reports and analysis as needed to identify trends and opportunities for improvement.in accordance with business requirements.

Utilize Valeris's values as the driving force behind the team’s success On time adherence to training deadlines for all corporate policies and procedures Ensure all SOPs are followed with consistency Perform additional tasks or projects as assigned.

Qualifications

• Completion of Bachelor's degree (or higher) required
• A degree in healthcare administration, social science or similar related fields is strongly preferred.
• Minimum two years of experience in healthcare access delivery or management is strongly preferred.
• 5-10 years of experience in insurance reimbursement, patient access, direct patient care, and/or patient education experience will be considered in lieu of degree.
• Will consider other certifications and five or more consecutive years of experience in relevant field.
• Certification examples include PACS (Prior Authorization Certified Specialist), CHES (Certified Health Education Specialist) or CCM in healthcare or social science (Certified Case Manager).
• Strong understanding of medical terminology, coding systems (ICD-10, CPT, HCPCS), and insurance processes.
• Demonstrated examples of executing within guardrails recognizing urgency and consistently delivering patient centric results.
• Excellent attention to detail and organizational skills.
• Ability to prioritize tasks and work efficiently in a fast-paced environment.
• Effective written and verbal communication and interpersonal skills, with the ability to interact professionally with diverse stakeholders.
• Demonstrates the ability to think critically and issue resolution.
• Knowledge of healthcare compliance regulations, including HIPAA and Medicare/Medicaid guidelines.
• Bi-lingual skills are a plus.

Physical Demands & Work Environment While performing the duties of this job, the employee is regularly required to talk or hear. The employee is frequently required to sit for long periods of time, use hands to type, handle or feel; and reach with hands and arms. Prefer candidates who can type at least 35 words per minute with 97% accuracy. Although very minimal, flexibility to travel as needed is preferred. This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, etc.

Why Work for Valeris?

• Medical, dental, and vision plans, including HSA- and FSA-eligible options, with Valeris contributing toward premium costs
• Additional health support, including telehealth and Employee Assistance Program (EAP) services
• Company match on Health Savings Account contributions
• Free Basic Life and AD&D coverage equal to your annual earnings, with a minimum of $50,000 and a maximum of $300,000
• Company-paid Short-Term Disability coverage, with the option to purchase Long-Term Disability
• 401(k) Retirement Savings Plan with 100% match on the first 5% you contribute, with immediate vesting
• Paid Time Off (PTO) and Sick Leave to support work-life balance
• Team members receive nine paid holidays plus two floating holidays

Our Commitment to Equal Opportunity At Valeris, we don’t just accept difference – we celebrate it, support it and we thrive on it for the benefit of our employees, our products and our community. Valeris is proud to be an equal opportunity employer.

A Name With Purpose. Inspired by those who work each day to transform access and enhance lives, our name emerges from the root valor: to be bold, brave, determined, be well, have worth. It speaks to integrity, simplicity, strength, and principled action. Valeris merges this with vision and an intention to redefine value at every step in the patient journey. We honor the science. We unlock the value. We do it with vision. We are Valeris. Purpose: Valeris represents measurable business impact through healthcare innovation that transforms lives. We combine cutting-edge technology with healthcare expertise to tackle challenges in access, affordability, and quality of care. Success means improving patient outcomes - everything we do is anchored in the value of improving human lives.