Sr. Coordinator, Individualized Care (Case Manager)
Core
Guide healthcare providers through patient therapy access processes, including benefit investigations, prior authorizations, and appeals to ensure timely product delivery.
Role type
Senior individual contributor case manager (patient access)
Builds
Patient therapy access pathways for specialty pharmaceutical manufacturers
Domain
Healthcare / Specialty Pharmacy / Insurance Payer Operations
Deliverable
client delivery
Required skills
Patient health insurance benefit investigation, Prior authorization processing, Appeals documentation, Payer/pharmacy issue mediation, High-volume call management, Regulatory compliance (HIPAA)
Preferred skills
Medicare/Medicaid payer policy knowledge, Affordable Care Act knowledge, Medical/Pharmacy billing and coding, Critical thinking
Technologies
None explicitly stated
Responsibilities
Investigate patient health insurance benefits, Initiate and document prior authorizations and step therapy reviews, Follow up with payers and specialty pharmacies to facilitate coverage, Mediate complex payer/pharmacy issues, Manage inbound and outbound calls for patient access support
Seniority
Mid-level, hands-on IC
