JOB TITLE: Case Manager (36133320)

PAY RATE: (USD)***/hour

LOCATION: 100% Remote

TRAINING AND WORK SCHEDULES: Your new hire training will take place M-F 8:00am-5:00pm CST, mandatory virtual attendance is required. Must attend 100% of training and pre-planned appointments/time off will not be accepted. This position is full-time (40 hours/week). 8:00am-5:00pm CST work schedule to be followed once training is complete.

*** 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.


Together, we can get life-changing therapies to patients who need them faster.


Responsibilities

Manage the entire care process with a sense of urgency from benefit investigation and verification to medication delivery, ensuring an exceptional patient experience

Conduct benefit verifications and collaborate with various healthcare providers, including physicians, specialty pharmacies, and insurance companies, to ensure seamless coordination of patient care and timely access to necessary services

Assist in obtaining insurance, prior authorization, and appeal requirements and outcomes

Help patients understand their insurance plan coverage, including out-of-pocket costs, and provide guidance on the appeals process if needed

Resolve patient's questions and any representative for the patient s concerns regarding status of their request for assistance

Demonstrate expertise in payer landscapes and insurance processes. Remain knowledgeable about long and short-range changes in the reimbursement environment including Medicare, Medicaid, Managed Care, and Commercial medical and pharmacy plans while planning for various scenarios that may impact prescribed products

Process enrollments via fax, phone, and electronically as needed

Scrutinize forms and supporting documentation thoroughly for any missing information or new information to be added to the database

Support inbound phone quue from patients, healthcare provider offices, SPs, and customers, striving for one-call resolution




Qualifications

2-4 years of industry experience with patient-facing or high touch customer interaction experience preferred

Previous Hub or Patient Support Service experience preferred

High School diploma or equivalent preferred

Knowledge of Medicare (A, B, C, D), Medicaid & Commercial payers policies and guidelines for coverage, preferred

Strong people skills that demonstrate flexibility, persistence, creativity, empathy, and trust.

Robust computer literacy skills including data entry and MS Office-based software programs

Strong understanding of pharmaceutical therapies, disease states, and medication adherence challenges preferred

Excellent written and oral communication, mediation, and problem-solving skills, including the ability to connect with patients, caregivers, and providers


What is expected of you and others at this level

Effectively applies knowledge of job and company policies and procedures to complete a variety of assignments

In-depth knowledge in technical or specialty area

Applies advanced skills to resolve complex problems independently

May modify process to resolve situations

Works independently within established procedures; may receive general guidance on new assignments

May provide general guidance or technical assistance to less experienced team members





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