Oncology Case Manager

ConnectMed360; Louisville (KY); On-site; USD 54,000 - 66,000; Full time

Benefits offered by this job

Medical, Dental, Vision

401k with match

Paid Time Off and Paid Holidays

Tuition Reimbursement

Company-paid life and disability insurance

Job summary

A healthcare support organization is seeking an Oncology Case Manager in Louisville, KY. This full-time position focuses on ensuring patient access to oncology medications, facilitating the reimbursement process, and building relationships with healthcare providers. Ideal candidates have 5+ years of pharmacy experience, possess strong communication skills, and understand healthcare policies. Join a team dedicated to improving the lives of patients with rare diseases while enjoying benefits such as health, dental, and tuition reimbursement.

Qualifications

• 5+ years of pharmacy experience required.
• 2+ years of patient support program experience desired.

Responsibilities

• Verify patient medication benefits and communicate coverage.
• Support prior authorization and appeal processes.
• Educate patients on therapy and assist with prescription fulfillment.

Skills

Strong verbal and written communication skills

Proactive mindset

Working knowledge of health insurance and medication reimbursement

Understanding HIPAA and privacy laws

Attention to detail

Education

High School Diploma or equivalent

Bachelor's or associate degree in pharmacy or healthcare preferred

Job description

Join to apply for the Oncology Case Manager role at ConnectMed360.

This position is Full‑time, on-site Monday–Friday. We offer quarterly incentive bonuses and plenty of growth opportunities. Come and join our team—making a difference for patients with rare diseases.

Salary is starting at $60k and up, depending on experience.

ConnectMed360 is a unique model creating customized patient support programs that connect manufacturers, providers, and patients to simplify the patient journey and deliver specialty medications and coordinated care quickly.

A career with us is more than just a job. It's an opportunity to connect and care for our patients, providers, communities, and each other. We attract extraordinary people who have a strong desire to live our mission—to better the lives of those battling cancer and rare diseases. Compassion is more important than numbers. We value teamwork, respect, integrity, and passion.

We succeed when you do. Our company and management team work hard to foster an environment that provides opportunities for both professional and personal growth.

Benefits

• Medical, Dental, Vision
• 401k with match
• Paid Time Off and Paid Holidays
• Tuition Reimbursement
• Company‑paid life, short- and long-term disability insurance

Role Overview

The Oncology Case Manager plays a key role in ensuring patients get access to an oral oncology medication by working directly with patients, prescribers, prescriber office staff, insurance providers, and care team members to facilitate the payer coverage process and drive holistic patient support. The Oncology Case Manager facilitates the medication reimbursement process, supports all involved in the coverage process—including prescriber office staff, specialty pharmacies, and patients or their caregivers—and manages reimbursement and hub patient enrollments in a specific geography, serving as the primary point of contact for the healthcare providers, patients, and client’s account managers in that area.

Major Responsibilities

• Perform benefit verification and coverage determination to identify and communicate the patient’s plan benefit coverage, including the need for prior authorization, appeal, tier exception, and/or formulary exclusions.
• Support the facilitation of prior authorization and appeal processes by gathering necessary clinical documentation and information, with guidance from senior team members as needed.
• Screen, enroll, and educate eligible patients of free goods programs where applicable as per program business rules.
• Perform patient outreach as needed to facilitate prescription fulfillment and therapy adherence as per program rules.
• Comprehensively understand the benefits investigation process, insurance plans, and available patient assistance programs.
• Operate both inbound and outbound calls as per the program‑approved FAQs, call guides, call scripts, and other program‑approved material.
• Field inbound calls from prescribers, patients, and client’s account teams as directed by the program‑approved FAQs.
• Inform and support patients by providing education and information throughout their therapy journey, including the status of their medication, needed processes, and connection to other stakeholders such as their oncology treatment care team or pharmacy.
• Assist in monitoring and maintaining the reauthorization of insurance coverage process to ensure continuity of therapy access.
• Serve as primary point of contact for incoming phone calls from patients, caregivers, physicians, and client’s department teams, proactively providing updates to internal and external stakeholders on patient cases in a timely manner.
• Create trusting relationships with physician offices and client department teams in their assigned region(s).
• Conduct scripted welcome calls and ongoing educational support calls to patients and office staff to introduce the program and confirm required enrollment information as necessary.
• Demonstrate an understanding of business rules, work instructions, and company‑approved communications for patients and HCPs; comprehensively understand the benefits investigation process, plan design, prior authorization criteria and processes, and all available patient support program offerings.
• Navigate operating platform with ease; document and meticulously note every update and aspect of the patient’s journey in their profile.
• Use discretion and independent judgment in handling customer complaints, while documenting and forwarding to appropriate team members.
• Communicate with Directors, Team Leads, Supervisor, and Program Manager on noteworthy program updates or obstacles.
• Coordinate with specialty pharmacies to obtain patient case updates and ensure the prescription process is moving forward; schedule shipments as needed with non‑commercial pharmacies.
• Exhibit excellent skills in verbal/written communication, computer/data‑entry/software proficiency, interpersonal and relationship‑building skills, self‑discipline, attention to detail, and the ability to maintain strict confidentiality.
• Report adverse events/product complaints in accordance with SOP and good manufacturer practices.
• Perform other duties as assigned by management.

Qualifications

Education & Learning Experience

• Required: High School Diploma or equivalent.
• Desired: Bachelor’s or associate degree, or equivalent program from a two‑year college or technical school, or certificate program in pharmacy and/or healthcare field. Preferred certifications include PACS (Prior Authorization Certified Specialist), CHES (Certified Health Education Specialist), CCM in healthcare or social science (Certified Case Manager), or Social Worker Field.

Work Experience

• Required: Minimum of 5 years of pharmacy experience.
• Desired: Minimum of 2 years of patient support program experience.

Skills & Knowledge

• Strong verbal and written communication skills with the ability to adapt communication style and word choice to effectively convey information to various audience types, including patients, healthcare providers, and cross‑functional teams.
• Proactive mindset where potential challenges are anticipated and initiative is taken towards effective solutions to support patients, providers, and care team members through access issues to ensure timely resolution and to prevent delays in treatment initiation.
• Working knowledge and experience with health insurance (pharmacy benefit), Medicare Part D coverage, prior authorization processes, and medication reimbursement specifically for specialty drugs.
• Working knowledge of U.S. health care policies and relevant legal, compliance, regulatory requirements.
• Understanding HIPAA and privacy laws and requirements and maintains patient confidentiality.
• Experience with adverse event and product quality complaint reporting.
• Limited travel may be required for trips to company meetings, key customer meetings, or other association meetings as determined by leadership.

Licenses & Certifications

• Required: N/A.
• Desired: Pharmacy technician, PACS, CHES, or CCM in healthcare or social science (Certified Case Manager).

Employment Details

Full‑time. On‑site, Monday–Friday.

Location

Location not specified. (ConnectMed360 location based on internal posting.)