Executive Case Manager

🕒 Ontem

🇺🇸 Estados Unidos – Remoto (EUA)

⏰ Tempo Integral

🟢 Júnior

🟡 Pleno

👔 Gerente

👻 Score fantasma 10%

O que significa: a chance de ninguém estar realmente contratando para esta vaga.Como ler: 60% ou mais significa que achamos que é uma vaga fantasma. Pontuações mais baixas preocupam menos.Por que essa pontuação:

• Aberta há 1 dia.
• As vagas desta empresa costumam ser preenchidas em 21 dias.
• Sem salário divulgado.

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Valeris

SiteLinkedInTodas as Vagas

1001 - 5000 funcionários

💊 Farmacêutico

🏥 Saúde

🤝 B2B

Pharmaceuticals • Healthcare • B2B

A Valeris é um parceiro totalmente integrado de comercialização em ciências da vida, formada pela fusão da PharmaCord e da Mercalis. A empresa oferece soluções abrangentes ao longo da cadeia de valor da saúde para ajudar as empresas de ciências da vida a levar produtos ao mercado e melhorar o acesso e a adesão dos pacientes. Valeris oferece dados e insights estratégicos, programas de suporte e acesso a pacientes e ferramentas de engajamento de prestadores de saúde, atendendo a mais de 500 clientes de ciências da vida e apoiando milhões de pacientes. Com sedes em Morrisville, Carolina do Norte, e Jeffersonville, Indiana, a Valeris se concentra em viabilizar a comercialização e serviços centrados no paciente para organizações farmacêuticas e de ciências da vida.

Descrição

• Manage the patient journey from initiation to closure • Complete benefit investigations • Track prior authorizations and denial appeals • Assist patients and callers/stakeholders through resolution via email, inbound/outbound calls, and Lynk technology • Provide education on access and reimbursement support tools, program benefits, and eligibility • Advise healthcare providers, patients, and caregivers • Educate healthcare provider offices on payer processes and procedures • Build trusted relationships with patients, prescribers, and client stakeholders • Support inbound and outbound calls to patients, caregivers, specialty pharmacies, and healthcare professionals • Perform post-benefits-investigation calls explaining coverage options and next steps • Manage client and healthcare provider inquiries • Triage patients to internal or external resources • Provide personalized case management and communicate benefit coverage and access next steps • Identify prior authorization, appeal, tier exception, and formulary exclusion needs • Follow up with payers and healthcare providers on submissions and outcomes • Coordinate nurse teaching with nurse educators • Support adherence services and identify peer-support resources • Manage prior-authorization reverification and re-enrollment needs • Identify and report adverse events, product complaints, special situation reports, and medical inquiries • Document reimbursement activities, claims status, payments, and appeals in Lynk • Generate reports and analysis to identify trends and improvement opportunities • Follow program procedures, SOPs, corporate policies, and training deadlines • Perform additional assigned tasks and projects

🎯 Requisitos

• Completion of Bachelor's degree or higher required; healthcare administration, social science, or similar fields strongly preferred • In lieu of a degree, five plus years of experience in insurance reimbursement, patient access, direct patient care, and/or patient education required • Two years of experience in insurance reimbursement, patient access, direct patient care, and/or patient education required • Minimum two years of experience in healthcare access delivery or management strongly preferred • Other certifications and five or more consecutive years of relevant experience may be considered • Strong understanding of medical terminology and coding systems including ICD-10, CPT, and HCPCS • Knowledge of insurance processes • Knowledge of healthcare compliance regulations, including HIPAA and Medicare/Medicaid guidelines • Excellent attention to detail and organizational skills • Ability to prioritize tasks and work efficiently in a fast-paced environment • Effective written and verbal communication and interpersonal skills • Ability to think critically and resolve issues • Bilingual skills are a plus • Remote work eligibility subject to work-from-home criteria and business need • Ability to type at least 35 words per minute with 97% accuracy preferred • Flexibility to travel as needed preferred • Successful completion of a background check and, depending on the position, a drug screen

🏖️ Benefícios

• Medical, dental, and vision plans, including HSA- and FSA-eligible options, with Valeris contributing toward premium costs • Telehealth and Employee Assistance Program (EAP) services • Company match on Health Savings Account contributions • Free Basic Life and AD&D coverage equal to annual earnings, with a minimum of $50,000 and a maximum of $300,000 • Company-paid Short-Term Disability coverage, with the option to purchase Long-Term Disability • 401(k) Retirement Savings Plan with 100% match on the first 5% contributed, with immediate vesting • Paid Time Off (PTO) and Sick Leave • Nine paid holidays plus two floating holidays • Opportunities for advancement and personal and professional growth • Challenging, stimulating work environment encouraging new ideas • Inclusive workplace and mission-driven culture • Background check and, depending on the position, drug screen required as a condition of employment

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