Case Manager - Specialty Pharmacy

• Manage specialty pharmacy case updates via direct communication, conference calls, and portal entries.
• Assist in creating and maintaining the process workflow and expectations between client staff and team members.
• Provide day-to-day communication on patient case statuses.
• Provide proactive support to client staff by troubleshooting and solving patient support situations.
• Provide prompt response to inquiries from the sales team regarding case status updates.
• Track all calls from client staff and perform trend analysis for potential enhancements.
• Provide detailed information to the client regarding payor denials.
• Conduct periodic insurance verification and/or authorizations for patient coverage.
• Obtain and maintain required prior authorizations.
• Create patient orders and associated prescription entries for new and refilled prescriptions.
• Arrange all necessary documents and materials for shipments initial and ongoing shipments.
• Manage REMS documents.
• Communicate with prescribers, including requesting new prescriptions.
• Assist team with financial assistance requests.
• Assist in preparing any ad hoc report requests from clients.
• Serve as a mentor for new team members.
• Obtain necessary consent forms for manufacturers or patient support organizations.
• Assist the pharmacist with day-to-day tasks such as filling prescriptions and entering prescription information into the patient management system for pharmacist verification.
• Monitor and collect patient satisfaction results for the program and share them with leadership and team members.
• Other duties as assigned, which may require additional time commitments.

• High school diploma, or equivalent, required. A higher degree is preferred.
• Minimum of four (4) years of experience working in a medical setting.
• Experience in the medical hematology/oncology field is preferred.
• Current Missouri BOP Pharmacy Technician license, or Nurse license in good standing.
• Ability to define problems, collect data, establish facts, and draw valid conclusions.
• Knowledge of medical terminology required.
• Knowledge of medical/pharmacy insurance benefit language- i.e. EOBs, deductibles, out-of-pocket, co-insurance, co-pays, etc.
• Knowledge of Medicare and Medicaid billing.
• Patient Assistance Program knowledge a plus.
• Experience with prior authorization and SMN preparation.
• Knowledge of insurance claim appeals.
• Computer literate and proficient with Microsoft Office.
• Ability to participate in and facilitate group meetings.
• Ability to thrive in a fast-paced environment with constantly changing and competing priorities.
• Excellent analytical skills and the ability to provide solutions to complex problems.
• Ability to be highly transparent, ethical, and driven. Relentless attention to detail, and the ability to be a creative self-starter and team player.
• Excellent written and verbal communication skills, and interpersonal skills required.
• Willingness to work a flexible schedule.

Optime Care provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.