Senior 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.

Responsibilities

The Senior Case Manager supports patient access to therapy through patient support services in accordance with the program business rules and HIPAA regulations. This role involves care coordination, insurance verification and navigation, patient advocacy, program expertise, and continuous improvement efforts.

This program will be working in the manufacturer’s CRM system, and this role will require resiliency to change as we will be working in a system that is evolving. 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.
 

• Process enrollments via inbound fax, phone, and electronically.

• Provide world-class service and receive inbound calls from patients, healthcare provider offices, SPs, and customers, striving for one-call resolution.

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

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

• Assigned as point of contact for physician offices, patients, and FRM (Field Reimbursement Managers) for patients enrolled into the patient support program.

• Manage the entire care process with a sense of urgency from benefit investigation/verification to medication delivery, ensuring an exceptional patient experience.

• Work with specialty pharmacies, insurance providers, and healthcare provider offices to help patients gain access to therapy.

• Compliantly coordinate the exchange of patient-related information with internal and external stakeholders. 

• Conduct benefit verifications and collaborate with various healthcare providers, including physicians, pharmacies, and insurance companies, to ensure seamless coordination of patient care and timely access to necessary services.

• Help patients understand their insurance plan coverage, including out-of-pocket costs, and provide guidance on the appeals process if needed.

• Assist in obtaining insurance, prior authorization, and appeal requirements and outcomes.

• Demonstrate expertise in payer landscapes and insurance processes. Remain knowledgeable about long and short-range changes in the reimbursement environment including Medicare, Medicaid, Managed Care, and Commercial medical and pharmacy plans while planning for various scenarios that may impact prescribed products

• Actively advocate for patients' needs by navigating complex healthcare systems, addressing concerns with providers, and securing necessary approvals for treatments and medications.

• Implement strategies to promote medication adherence, including patient education, regular check-ins, and addressing potential barriers to compliance.

• Take ownership of intricate patient cases involving multiple medications, chronic conditions, or challenging adherence issues, developing personalized care plans, and monitoring progress closely

• Evaluate patient eligibility for assistance programs and assist with enrollment when applicable.

• Create and implement action plans to address patient access barriers and demonstrate accountability in execution, driving for success and results.

• Remain updated on available patient resources and diligently oversee systems and procedures to maintain accuracy and efficiency.

• Track key patient metrics, analyzing data to identify trends and areas for improvement, and generating reports for stakeholders. 

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