Case Manager - Patient Services - Healthcare

Core Duties/Responsibilities:

• Act as a single point of contact between the internal team, client, providers, payor, facility, and patient as needed.
• Support cases through approval/denial process with a sense of urgency while maintaining accuracy.
• Collaborate and provide direction to the internal and external stakeholders (i.e., Payor Specialist Team, Reimbursement Team, Clinical Team, client sales/MSL) and coordinate efforts to ensure accuracy and completeness of each case.
• Identify and share trends impacting business processes with management.
• Prioritize and act on key client activities and follow up with customers to ensure problems are solved.
• Manage through ambiguity while designing innovative client and payor solutions.
• Make sound independent decisions in urgent and non-routine situations pertaining to client and patient scenarios.
• Interpret complex clinical documentation to prepare authorization documentation for payor submission in relation to medical policy criteria for coverage.
• Partner with the interdisciplinary team to champion their clients, patients, and customers, and is responsible for the life cycle of their case to ensure successful completion.
• Provide resources to patients, caregivers, health care providers and clients with resources available for financial assistance and transportation.
• Provide compassionate and empathetic support to patients and caregivers.

Skills / Requirements:

• Maintains open, effective dialogue with effective communication and is both clear and thorough in reports, documentation, and other written communications.
• High level of ability to coordinate multiple priorities and activities to accomplish goals.
• Ability to independently manage case load, prioritize work, and use time management skills to manage deliverables.
• Critical thinking and strong problem solving
• Suggests creative ideas and innovative solutions while exploring multiple alternatives and approaches to overcome obstacles and find solutions.
• Excellent follow-through with solid levels of determination and tenacity.
• Remains calm and productive during transitions or changing circumstances.
• Demonstrates composure and professionalism under difficult circumstances.
• Ability to communicate effectively both orally and in writing with a focus on customer satisfaction, with empathy, drive, and commitment to exceptional service.
• Possess a strong understanding of the US Healthcare System, public and private payer nuances, and patient access challenges for new to market, high dollar or highly complex medical interventions, products, therapies.
• Ability to leverage professional expertise and apply company policies and procedures to resolve challenges.
• Ability to develop, maintain and navigate relationships.
• Ability to interpret and understand medical documentation as it relates to each specific case and how it applies to a specific medical policy.
• Ability to be agile and adaptable in responses to rapidly changing processes and consumer needs.