Pharmacy Enhanced Case Management Coordinator III

POSITION SUMMARY

An ECM Coordinator supports department staff with administrative tasks related to a member’s medical condition(s), department case work, communication with internal and external stakeholders, and manage audits. This role will engage with members to offer support and resources related to their medical condition(s) through Allied Care.

ESSENTIAL FUNCTIONS 

• Facilitate reviews, referrals, and outreach for referral-based proprietary strategies as well as engaging with members across Medical Management products

• Document all engagement accurately and concisely within the Microsoft Customer Relationship Management (CRM) system

• Manage escalated and time sensitive case management questions received from members, broker relationships, and internal and external Allied stakeholders

• Collaborate with strategic vendor partners to provide supportive services and support to members

• Lead and facilitate claims auditing in conjunction with ECM Coordinators.

• Complete department auditing related to daily tasks to ensure accuracy and identify escalations

• Identify impactful scenarios through appropriate closing summaries in timely fashion.

• Share impactful scenarios with the department’s leadership team to deliver to internal departments, such as Sales, Operations, and Executive leadership

• Identifying escalations for department leadership team, as appropriate

• Other duties as assigned 

EDUCATION

• Bachelor’s Degree or equivalent work experience, required

EXPERIENCE AND SKILLS

• At least 3-5 years of administrative support experience required.

• Focus on patient-provider engagement, needs assessments, coordination of care, and or patient treatment adherence within the healthcare or social service industry preferred

• Experience in pharmacy claims or specialty drugs preferred

• Understanding of intermittent medical terminology such as CPT, HCPC, and diagnostic codes

• Understanding of basic benefit plan design terminology such as deductible, out-of-pocket, prescription drugs, physical medicine services, etc.

• Strong verbal and written communication skills

• Strong analytical and problem-solving skills

COMPETENCIES

• Communication

• Customer Focus

• Accountability

• Functional/Technical Job Skills

PHYSICAL DEMANDS

• This is a standard desk role – long periods of sitting and working on a computer are required.

WORK ENVIROMENT

• Remote

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