Sr Coordinator, Individualized Care (Case Manager)

Cardinal Health Sonexus™ Access and Patient Support helps specialty pharmaceutical manufacturers remove barriers to care so that patients can access, afford and remain on the therapy they need for a better quality of life. Our diverse expertise in pharma, payer and hub services allows us to deliver best-in-class solutions—driving brand and patient markers of success. We’re continuously integrating advanced and emerging technologies to streamline patient onboarding, qualification and adherence. Our non-commercial specialty pharmacy is centralized at our custom-designed facility outside of Dallas, Texas, empowering manufacturers to rethink the reach and impact of their products.

Together, we can get life-changing therapies to patients who need them—faster.

What Clinical Operations and Individualized Care contributes to Cardinal Health 

Clinical Operations is responsible for providing clinical specialties support and expertise in the areas of advice and consulting, research and patient care to internal business units and external customers  

What is expected of you and others at this level 

• Applies acquired job skills and company policies and procedures to complete standard tasks 

• Works on routine assignments that require basic problem resolution 

• Refers to policies and past practices for guidance 

• Receives general direction on standard work; receives detailed instruction on new assignments 

• Refers to policies and past practices for guidance 

• Receives general direction on standard work; receives detailed instruction on new assignments 

• Consults with supervisor or senior peers on complex and unusual problems 

Responsibilities

The Case Manager supports patient access to therapy through Reimbursement Support Services in accordance with the program business rules and HIPAA regulations. This position is responsible for guiding the healthcare providers through the various process steps in support of their patient’s journey to therapy. These steps include patient referral intake, investigating all patient health insurance benefits, identifying & initiating prior authorization and step therapy reviews, proactively following up with various partners including the insurance payers, specialty pharmacies, support organizations, and the patient/physician to facilitate coverage and delivery of product in a timely manner. 

• Must demonstrate efficiency and strong organizational skill 

• Mediate effective resolution for complex payer/pharmacy issues toward a positive outcome to de-escalate 

• Proactive follow-up with various contacts to ensure patient access to therapy 

• Call interactions are primarily outbound: Must demonstrate superior customer support talents that remain in compliance with standard call quality expectations. 

• Must communicate clearly and effectively in both a written and verbal format 

• Must meet the daily task and benefit investigation goals associated with a high enrollment volume/low patient interaction program. 

Qualifications 

• High School Diploma or GED preferred

• 3-6 years experience in related field preferred 

• 1-2 years experience conducting and documenting patient health insurance benefit investigations, prior authorizations, and appeals, preferred  

• Knowledge of Medicare, Medicaid and Commercially insured payer common practices and policies, preferred 

• Critical and creative thinking, preferred 

• Knowledge of the Health Insurance Market Place and the Affordable Care Act preferred 

• Knowledge of Medical/Pharmacy billing and coding is preferred 

• Important to have a strong attention to detail 
   

TRAINING AND WORK SCHEDULES: Your new hire training will take place 8:00am-5:00pm CT the first week of employment.  Attendance is mandatory.

This position is full-time (40 hours/week).  Employees are required to have flexibility to work a scheduled shift of 7am-7pm CT.

REMOTE DETAILS: All U.S. residents are eligible to apply to this position. You will work remotely, full-time. It will require a dedicated, quiet, private, distraction free environment with access to high-speed internet. We will provide you with the computer, technology and equipment needed to successfully perform your job. You will be responsible for providing high-speed internet. Internet requirements include the following:

Maintain a secure, high-speed, broadband internet connection (DSL, Cable, or Fiber) at the remote location. Dial-up, satellite, WIFI, Cellular connections are NOT