Sr. Coordinator, Individualized Care

Cardinal Health; Columbus (OH); Remote; USD 29,000 - 42,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Health Savings Account

401k savings plan

MyFlexPay access

FSAs

Disability coverage

Work-Life resources

Paid parental leave

Wellness programs

Job summary

Cardinal Health is seeking a remote, full-time Case Manager to support patient access to therapy through reimbursement and benefit investigations. You will guide providers through referrals, insurance benefits, and prior authorizations, coordinating with payers and pharmacies to ensure timely coverage.

The role emphasizes accuracy, adherence to HIPAA, and collaboration with a multidisciplinary team to optimize patient journeys in a high-enrollment environment.

Qualifications

• 3–6 years experience in related field preferred.
• Experience with major medical fertility and travel & lodging BI preferred.
• 1–2 years experience conducting and documenting patient health insurance benefit investigations, prior authorizations, and appeals preferred.
• Knowledge of Medicare, Medicaid and commercially insured payer practices preferred.
• Knowledge of Health Insurance Marketplace and ACA preferred.
• Knowledge of medical/pharmacy billing and coding preferred.
• Strong attention to detail.

Responsibilities

• Guide patient access to therapy through reimbursement support services.
• Assist healthcare providers through patient referral intake and benefit investigations.
• Identify and initiate prior authorizations and step-therapy reviews.
• Proactively follow up with payers, pharmacies and support organizations to facilitate coverage.
• Ensure compliance with HIPAA and program business rules.

Skills

Payer experience

Prior authorizations

Benefits investigations

Medicare/Medicaid knowledge

Billing & coding knowledge

Attention to detail

Fertility BI experience

Travel & Lodging BI experience

Healthcare experience

Education

High School Diploma / GED

Job description

US-Nationwide-FIELD

Full time

20188722

Cardinal Health Sonexus™ Access and Patient Support helps specialty pharmaceutical manufacturers remove barriers to care so that patients can access, afford and remain on the therapy they need for a better quality of life. Our diverse expertise in pharma, payer and hub services allows us to deliver best-in‑class solutions—driving brand and patient markers of success. We’re continuously integrating advanced and emerging technologies to streamline patient onboarding, qualification and adherence. Our non-commercial specialty pharmacy is centralized at our custom-designed facility outside of Dallas, Texas, empowering manufacturers to rethink the reach and impact of their products.

What Individualized Care contributes to Cardinal Health

Delivering an exclusive model that fully integrates direct drug distribution to site-of-care with non-commercial pharmacy services, patient access support, and financial programs, Sonexus Health, a subsidiary of Cardinal Health, helps specialty pharmaceutical manufacturers have a greater connection to the customer experience and better control of product success. Personalized service and creative solutions executed through a flexible technology platform means providers are more confident in prescribing drugs, patients can more quickly obtain and complete therapy, and manufacturers can directly access more actionable insight than ever before. With all services centralized in our custom-designed facility outside of Dallas, Texas, Sonexus Health helps manufacturers rethink how far their products can go.

What is expected of you and others at this level

• Applies acquired job skills and company policies and procedures to complete standard tasks
• Works on routine assignments that require basic problem resolution
• Refers to policies and past practices for guidance
• Receives general direction on standard work; receives detailed instruction on new assignments
• Refers to policies and past practices for guidance
• Receives general direction on standard work; receives detailed instruction on new assignments
• Consults with supervisor or senior peers on complex and unusual problems

Accountabilities

The Case Manager supports patient access to therapy through Reimbursement Support Services in accordance with the program business rules and HIPAA regulations. This position is responsible for guiding the healthcare providers through the various process steps in support of their patient’s journey to therapy. These steps include patient referral intake, investigating all patient health insurance benefits, identifying & initiating prior authorization and step therapy reviews, proactively following up with various partners including the insurance payers, specialty pharmacies, and support organizations to facilitate coverage and delivery of product in a timely manner.

• Must demonstrate efficiency and strong organizational skill
• Mediate effective resolution for complex payer/pharmacy issues toward a positive outcome to de-escalate
• Proactive follow-up with various contacts to ensure patient access to therapy
• Call interactions are inbound & outbound: Must demonstrate superior customer support talents that remain in compliance with standard call quality expectations.
• Must communicate clearly and effectively in both a written and verbal format
• Must meet the daily task and benefit investigation goals associated with a high enrollment volume/low patient interaction program.

Qualifications

• High School Diploma, GED, or equivalent work experience
• 3-6 years experience in related field preferred
• Experience with major medical Fertility and Travel & Lodging BI experience preferred
• 1-2 years experience conducting and documenting patient health insurance benefit investigations, prior authorizations, and appeals, preferred
• Knowledge of Medicare, Medicaid and Commercially insured payer common practices and policies, preferred
• Critical and creative thinking, preferred
• Knowledge of the Health Insurance Market Place and the Affordable Care Act preferred
• Knowledge of Medical/Pharmacy billing and coding is preferred
• Important to have a strong attention to detail

TRAINING AND WORK SCHEDULES:

Your new hire training will take place 8:00am-5:00pm CT, mandatory attendance is required.

This position is full-time (40 hours/week). Employees are required to have flexibility to work shift schedules during our normal business hours of Monday-Friday, 7:00am- 7:00pm CT.

Anticipated hourly range:

$21.40 per hour - $30.60 per hour

Bonus eligible:

No

Benefits:

• Medical, dental and vision coverage
• Paid time off plan
• Health savings account (HSA)
• 401k savings plan
• Access to wages before pay day with myFlexPay
• Flexible spending accounts (FSAs)
• Short- and long-term disability coverage
• Work-Life resources
• Paid parental leave
• Healthy lifestyle programs

REMOTE DETAILS:

You will work remotely, full-time. It will require a dedicated, quiet, private, distraction free environment with access to high-speed internet. We will provide you with the computer, technology and equipment needed to successfully perform your job. You will be responsible for providing high-speed internet. Internet requirements include the following:

Maintain a secure, high-speed, broadband internet connection (DSL, Cable, or Fiber) at the remote location. Dial-up, satellite, WIFI, Cellular connections are NOT acceptable . Download speed of 15Mbps (megabyte per second)

• Upload speed of 5Mbps (megabyte per second)
• Ping Rate Maximum of 30ms (milliseconds)
• Hardwired to the router
• Surge protector with Network Line Protection for CAH issued equipment

Cardinal Health supports an inclusive workplace that values diversity of thought, experience and background. We celebrate the power of our differences to create better solutions for our customers by ensuring employees can be their authentic selves each day. Cardinal Health is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, ancestry, age, physical or mental disability, sex, sexual orientation, gender identity/expression, pregnancy, veteran status, marital status, creed, status with regard to public assistance, genetic status or any other status protected by federal, state or local law.

Headquartered in Dublin, Ohio, Cardinal Health, Inc. (NYSE: CAH) is a distributor of pharmaceuticals, a global manufacturer and distributor of medical and laboratory products, and a provider of performance and data solutions for healthcare facilities.

We are a crucial link between the clinical and operational sides of healthcare, delivering end‑to‑end solutions and data‑driving insights that advance healthcare and improve lives every day. With deep partnerships, diverse perspectives and innovative digital solutions, we build connections across the continuum of care.

With more than 50 years of experience, we seize the opportunity to address healthcare's most complicated challenges — now, and in the future.

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