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Case Manager - Benefits Specialist

Louisville, KY

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Summary of Job:  To monitor processing of cases for patients with specialty pharmacy vendors and home health agencies to overcome delay in turnaround times and other obstacles. The Case Manager will be in regular contact with vendors. Occasionally, the Case Manager will contact physician offices, payers, specialty pharmacies, and pharmaceutical company representatives.

Key Responsibilities:

  • Monitors drug shipments and patient training between patients, physician offices and specialty pharmacies 
  • Work with vendor contacts (specialty pharmacies and/or Home Health agencies) to expedite approval and delivery of medication and injection administration and/or injection teach 
  • Understand reason for denial and take appropriate actions to resolve case 
  • Re-triage cases to appropriate specialty pharmacy when/if appropriate in a timely manner 
  • Respond to vendor statuses (written, electronic or verbal) making appropriate entries into NG system 
  • Set follow up alarms as appropriate to resolve patient prescription request 
  • Communicate with Case Managers II (CM II), Case Managers III (CM III), and to work with medical practices, sales representatives regarding the status of cases 
  • Provide consultative services where issues arise on how obstacles can be overcome in order to get patient on paid therapy 
  • Works with CM II and CM III to obtain missing information •Develops and works daily report and maintains e-mail of pending cases in a timely fashion 
  • Coordinates and schedules conference calls with vendor contact and/or home health company to review status of cases  Maintains all patient confidentiality
  • Other duties and responsibilities as assigned by supervisor
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