Case Manager (Non-Clinical)

Job Description
The Case Manager / Patient Support Navigator is a vital part of the front-line patient and caregiver support. The CM-PSN acts as a Social Determinants of Health (SDOH) resource for patients and family members throughout their patient assistance journey. The CM-PSN provides patient-centered support, acts as liaison between patients, caregivers, medical professionals, internal and external matrix partners.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
Our employees are tasked with delivering excellent business results through the efforts of their teams. These results are achieved by:
Assist patients/caregivers as appropriate to function as a patient advocate, educator, and single point of contact for patients, and caregivers.
Field incoming phone calls from patients, caregivers, and providers;
triage calls and route to the appropriate team for further action if applicable.
Provide scripted information on how patients can access reliable sources of information through various resources available.
Assess patient’s needs upon initial welcome call and through navigation, matching the patient’s needs with appropriate resources and support within program offerings.
Provide newly registered patients with a welcome call including patient support materials and resources.
Adhere to all appropriate compliance standards outlined in business rules, policies, and SOPs.
Assess patient barriers based on SDOH which include factors such as, but not limited to, socioeconomic status, education, housing, transportation, food, physical environment, employment, and social support networks, as well as access to health care. Refer patients to aligned resources within program service offerings.
Identify patients closest SDOH resource outlet and assist in scheduling to obtain available resources.
Receive incoming data related to patient support programs such as enrollment forms, insurance cards for benefits investigations for review, save related documents within the patient database, triage, and route data to the appropriate department or team member as applicable.
Conduct benefit investigation and prior authorization with payers.
Provide updates and partner with all team members to ensure patients are served in a timely manner.
Participate and support multiple ongoing department projects.
Ensure patient centered excellence in supporting all internal and external stakeholders involved in the patient journey.
Other tasks and projects as assigned client inquiries, exceptions, management mailbox, reconciliation reports, and workforce functions.
All other duties as assigned.
Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions of this position.
EXPECTATIONS OF THE JOB:
Job Duties
Learn, understand, and follow all company and client policies and procedures.
Accept being accountable and responsible in work practices and expectations. Delivers what is promised.
Foster a collaborative, team-oriented attitude. Communicates effectively with others with clarity and transparency.
Use innovative critical and creative thinking to evaluate and solve work and customer issues.
Seek assistance in solving work problems through collaboration and information seeking.
Personal Accountability
Attendance – Excellent attendance is a key success driver for this role
Compliance Wire Online Training – at least 90% on-time completion
Professional, positive, ethical, and responsible behavior
Collaboration, proactive, and effective communication
Ability to self-manage, multitask and problem solve
Proficient computer skills
Demonstrate cultural beliefs
Agents who regularly perform at or above the targeted performance levels will be eligible for remote work opportunities with the following considerationsSupervisor approval
Proof of HIPAA compliant workspace
Proof of secure internet connectivity with sufficient bandwidth to successfully conduct the role activities
Maintain in office performance &
quality levels and schedule adherence
Agree to and sign the Hybrid Remote Work policy
The above list reflects the general details necessary to describe the expectations of the position and is not to be construed as the only expectations that may be assigned for the position.
An individual in this position must be able to successfully perform the expectations listed above.