Sr. Coordinator, Individualized Care (Case Manager)

Cardinal Health; United States; On-site; USD 29,000 - 42,000; Full time

Benefits offered by this job

Medical, dental and vision coverage

Paid time off plan

Health savings account (HSA)

401k savings plan

Access to wages before pay day with my

FlexPay (minimum pay before payday)

Flexible spending accounts (FSAs)

Disability coverage

Work-Life resources

Paid parental leave

Healthy lifestyle programs

Job summary

Cardinal Health seeks a remote Case Manager to support patient access to therapy through Reimbursement Support Services, guiding providers through referral intake, benefits investigations and prior authorization steps. You will collaborate with payers, specialty pharmacies, and support organizations to ensure timely coverage and delivery of therapy.

Ideal candidates have 3–6 years in related fields, strong attention to detail, and familiarity with Medicare/Medicaid processes and the Health

Qualifications

• High School Diploma, GED, or equivalent work experience.
• 3-6 years experience in related field 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
• 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

Responsibilities

• The Case Manager supports patient access to therapy through Reimbursement Support Services in accordance with the program business rules and HIPAA regulations.
• Guide healthcare providers through the various process steps in support of their patient’s journey to therapy, including referral intake, benefits investigations, prior authorizations and step therapy reviews.
• Proactively follow up with insurance payers, specialty pharmacies, and support organizations to facilitate coverage and timely delivery of product.

Skills

Customer service

Problem solving

Communication

Organizational skills

Attention to detail

Education

High School Diploma, GED, or equivalent

Job description

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
• 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

Candidates who are back-to-work, people with disabilities, without a college degree, and Veterans are encouraged to apply. 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/Affirmative Action 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.