Executive Case Manager; Remote

Join to Apply for the Executive Case Manager (Remote)

Join to apply for the Executive Case Manager (Remote) role at Pharma Cord
.

Due to an increase in hiring scams, please be aware that if you are selected to move forward in our hiring process, a member of our Talent Acquisition team will contact you directly using an official or email address regarding next steps in our interview process.

Pharma Cord will never use Microsoft Teams to reach out to candidates for interview scheduling. Video interviews are typically conducted via Microsoft Teams; official meeting links will always be sent from an or email address, or through our scheduling platform, Calendly.

We will never request your bank account information or send a check (electronic or physical) to purchase home office equipment at any stage of the hiring process.

If you receive any suspicious communication regarding employment with Pharma Cord, please report it immediately to our Talent Acquisition team at .

This is a remote role. Candidates must reside in the state of Indiana.

When you join the team as an Executive Case Manager, you'll have the opportunity to make a difference in the lives of our patients each day as they look to you as part of their dedicated support team for helping them navigate the tricky process of getting access to their complex medication. You will compassionately deliver an exceptional experience to many patients per day, always remembering that every prescription or document belongs to a real person who is looking for thorough and efficient management of their records.

You will adjust your approach to their needs by communicating clearly, focusing on the accuracy of the details of their medical records, mastering program requirements, and ensuring prescriptions or cases are handled in a timely manner. An Executive Case Manager has the ability to translate knowledge into patient‑friendly language and education.

A typical day will include ownership of the patient journey from initiation to closure using critical thinking skills and knowledge of program and industry rules and standards. This includes completing benefit investigations, tracking prior authorizations/denial appeals, and assisting patients or other callers/stakeholders through resolution via email, inbound/outbound calls, and using our patented technology, Lynk. This role requires a strong understanding of pharmacy and medical billing and coding, excellent communication skills, and the ability to navigate complex reimbursement processes.

• Relationship Management
  • Build trusted relationships with patients, prescribers, and appropriate client stakeholders regarding reimbursement inquiries and challenges through proactive communication, timely and accurate execution of deliverables, and a relentless passion for helping patients.
  • Manage all relationships in a manner that adheres to all relevant laws, regulations, program‑specific operating procedures, and industry standards related to access and affordability, including HIPAA and insurance guidelines.
  • Support inbound and outbound calls to patients, caregivers, specialty pharmacies, and healthcare professionals.
  • Performs post‑Benefits Investigation calls to patients and/or physicians explaining coverage options and next steps in the access journey.
  • Manage all client inquiries as appropriate, such as case‑specific statuses.
  • Manage HCP inquiries, as applicable, pursuant to business rules.
• Inbound Call Management
  • Manages inbound calls as directed by the program‑approved FAQs.
  • Triage patients to internal or external resources as appropriate.
• Personalized Case Management
  • Provides personalized case management to patients and HCPs, including outbound communication to HCPs, specialty pharmacies, and patients to communicate benefit coverage and/or help drive next steps in obtaining coverage or access to prescribed medicine.
  • Leverages electronic tools to identify benefits and payer coverage; completes manual benefit investigation as needed.
  • Identifies and communicates patient’s plan benefit coverage, including need for prior authorization, appeal, tier exception, and/or formulary…