Nurse case manager Jobs in Carrollton, TX

Case Manager

Location: 100% WFH-Remote Schedule: Must be able to work any 8hr shift between 7AM-7PM (CST) as assigned. Onboarding Training schedule will be 8AM-5PM (CST) Training typically lasts for first 4-6 weeks of the assignment. Virtual attendance is mandatory.

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 patient experiences through maximization of efficiency, productivity, and quality. 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.

Duties:

• Monitor system accounts for new Patient cases
• Conduct outbound calls to patients to confirm approval/denials of coverage, co-pays and verification of specialty pharmacies dispensing medication(s)
• Contact insurance companies as required to obtain / enter accurate benefit information related to patient coverage
• Mediate effective resolution for complex payer/pharmacy issues toward a positive outcome
• Maintain quality while providing an empathetic and supportive experience to the patients, providers, and physician offices
• Resolve patient's questions and concerns regarding status of their request for assistance
• Enter detailed information into company proprietary software while conversing via telephone
• Steward patient accounts from initial contact through final approval/denial
• Process all patient applications in accordance to set policy, procedures, and PHI compliance
• Works with / provides updates to team members and leadership on patients' cases
• Ability to identify, document and compliantly submit Adverse Events during customer contact or via received documentation
• Conduct research associated with alternative funding / foundations to determine patient eligibility to receive product
• Effectively applies knowledge of job and company policies and procedures to complete a variety of assignments
• Applies advanced skills to resolve complex problems independently
• Works independently within established procedures

Skills:

• Ability to multitask, utilizing specific software programs while speaking with patients and/or healthcare staff.
• Ability to type a minimum of 40 WPM.
• Ability to transcribe (type) accurate notes while speaking to customer.
• Strong Microsoft Products experience required.
• Ability to navigate video conferencing tools such as Microsoft Teams and Zoom.
• Strong video conferencing experience.
• Must have the ability to work via video conferencing as required by leadership.
• Organized with the ability to prioritize multiple, concurrent assignments and work with a sense of urgency.
• Exceptional communication skills both verbally and written.
• Strong attention-to-detail and quality documentation.
• Exceptional, professional verbal communication skills with friendly, empathetic, and patient centric focus.
• Independent worker and self-starter with solid time management skills and ability to work with high volume production teams.
• Continuous learner with a desire to move into a senior level role.
• Solid work-ethic and driven to achieve daily/weekly metrics.
• Strict adherence to company attendance policies.
• Self-starter with demonstrated initiative, creativity and a willingness to be a team player.

Remote Details:

• All U.S. residents are eligible to apply to this position. 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 Inability to meet these requirements at any time may result in termination of the contract / employment.

Education:

• Minimum of HS diploma; additional education preferred
• Previous healthcare experience with insurance or in pharmaceutical industry, preferred
• Pharmacy benefits management experience preferred with specific knowledge of Medicare, Medicaid and commercially insured payer common practices and policies, preferred
• Previous prior authorization and appeals experience highly desired

EEO: "Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans."