Case Manager 11:30-8

Case Manager 

This role will have a dedicated schedule of 11:30am-8pm EST Monday-Friday.

Purpose:

The Case Manager (CM) is a phone-based, patient-facing role responsible for supporting patients and healthcare providers (HCPs) throughout the access and reimbursement process. The RPCM serves as the primary point of contact for both patients and HCP offices, ensuring proactive communication, accurate information exchange, and timely case resolution to support access to therapy.

The CM conducts inbound and outbound calls to provide updates, resolve inquiries, and ensure first-call resolution whenever possible. They will work directly with HCPs to obtain missing information, guide them through the prior authorization (PA) and appeal processes, and confirm that payer-required documentation is submitted accurately and on time. In parallel, the RPCM provides proactive outreach and responsive support to patients, delivering clear communication on case status, next steps, and reimbursement outcomes.

This role requires excellent communication and organization skills, a strong understanding of the payer and reimbursement landscape, and the ability to collaborate across multiple internal teams. The RPCM is regionally aligned to field teams and works closely with internal stakeholders, including Reimbursement, Clinical, Operations, Non-Commercial Pharmacy, and Program Management, to ensure a seamless and supportive patient experience.

Responsibilities:

• Primary point of contact and case manager for client and customer needs, inquiries and escalations.
• Serve as the primary point of contact for patients and HCP offices regarding case status, documentation needs, and next steps in the access process.
• Handle inbound calls from patients and HCPs and ensure first-call resolution whenever possible.
• Coordinate all patient and relevant HCP-related support and access services across all functions including but not limited to: support on status update calls, missing information, benefits verification, prior authorization and appeals, triage to specialty pharmacy, and any necessary follow ups.
• Maintain clear, concise, and accurate documentation on all accounts according to Standard Operating Procedures.
• Conduct initial welcome calls to patients informing them of available services as well as future targeted outreach to provide ongoing support. 
• Maintain frequent touchpoints through outreach to providers and patients to communicate progress throughout their journey.   
• Work independently to complete assigned work in accordance with Standard Operating Procedures and defined service levels to complete program enrollment, answer inquiries, and coordinate access to free good programs.
• Apply defined business rules to qualify patients for manufacturer supported programs.
• Provide support, education, and status updates to field teams, HCP offices, and patients to ensure efficient referral processing, triaging, and shipment set ups. 
• Processes free good requests in a timely fashion and verifies appropriate program utilization and criteria.
• PAP re-approval verification for continued eligibility.
• Independently and effectively identify adverse events and product complaints.
• Use problem solving skills and professional judgement to independently make sound decisions for timely case resolution.
• Provide concierge-level service to internal and external customers; resolve any customer and client requests in a timely and accurate manner and escalate appropriately.
• Ability to coordinate and collaborate with manufacturer representatives, HCP offices and other key personnel on complex cases which require strategic intervention. Independently and effectively resolves complex issues with creativity and innovation while maintaining compliance. 
• Maintain frequent phone/email contact with internal operational staff. Utilize outbound faxes, email alerts, and mailings per program guidelines.
• Strong compliance mindset, demonstrating clear understanding of patient privacy laws. 
• Active participation in building and maintaining respectful, collaborative team relationships, exercising, and encouraging positivity. 
• This position may require flexibility in scheduling, with shifts occurring between 8:00AM and 8:00PM EST, Monday through Friday. Employees should be prepared to work within this timeframe as needed. 
• Other duties as assigned.

Required Qualifications:

• High school diploma plus 2+ years recent case management experience
• Previous 2+ years in a pharmacy, healthcare setting, and/or insurance background
• Advanced knowledge and experience in healthcare setting
• Strong interpersonal skills; ability to communicate effectively both orally and in writing with a focus on customer satisfaction
• Empathy, drive and commitment to exceptional service
• Ability to build productive internal/external working relationships
• Ability to independently manage case load, prioritize work, and use time management skills to meet deliverables

Preferred Qualifications:

• Undergraduate degree and/or equivalent work experience  
• Certified Pharmacy Technician (CPhT) or Case Management Experience 
• Bilingual Spanish speaking and writing is plus
• Strong analytical and organizational skills with meticulous attention to detail
• Experience with benefit investigation and verification of prescription benefits
• Working knowledge of Third-Party and other Foundation programs a major plus
• Understanding of plan types – Government, Commercial, Medicare, Medicaid, VA, Federal 
• Knowledge of insurance structure (ex PBM’s, major medical plans, co-pay assistance /cards) 
• Ability to proficiently use Microsoft Teams, Excel, Outlook and Word

Work Environment:

RareMed offers a hybrid work structure, combining remote work and in-office requirements. The frequency of onsite requirements will vary depending on role, operational needs, meetings, client visits, or team collaboration activities. Employees must be within commuting distance to Pittsburgh, PA, and able to report to the office when needed. We will provide advance notice when possible. This role routinely involves standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines. When telecommuting, employees must have reliable internet access to utilize required systems and software required for the position's responsibilities. The amount of time the employee is expected to work per day or pay period will not change while working from home. Employees are responsible for the set-up of their home office environment, including physical set-up, internet connection, phone line, electricity, lighting, comfortable temperature, furniture, etc. Employee’s teleworking space should be separate and distinct from their “home space” and allow for privacy. 

Physical Demands:
While performing the duties of this job, the employee is regularly required to talk or hear. The employee frequently is required to stand; walk; use hands and fingers, handle or feel; and reach with hands and arms. 

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function of the job.