Job Description

Job Description

Job Description

In general, the Key Accounts Case Manager will be responsible for the following tasks:

• Review and interpret prescriptions to ensure appropriate therapies.

• Review medication policies to ensure compliance with requirements for billing purposes.

• Transcribe prescription data in preparation for Pharmacist verification.

• Contact all new patients to inform them of prior authorization requirements and welcome them to Alivia Specialty Pharmacy.

• Gather all necessary information and documents to support the approval request to the Health Plan or PBM.

• Communicate and send necessary documents to insurance companies or other payers to fulfill prior authorization requirements.

• Answer incoming pharmacy calls with excellent customer service standards and follow up on pending internal or external tasks.

• Meet the quantitative and qualitative production standards set by management.

• Obtain the patient’s medication list for DUR research.

• Submit and review prescription drug insurance claims to be delivered to patients and providers.

• Refer to the Patient Assistance Program department in cases where the patient cannot afford deductibles.

• Develop relationships and act as a liaison with physicians, patients, infusion centers, manufacturers, and Patient Assistance Programs.

• Identify and resolve rejected requests by health plans, including facilitating access to comparable medication regimens; refer to pharmacist in case of potential pharmaceutical alternatives.

• Monitor assistance balances for each enrolled patient to ensure funding is available through the completion of therapy (e.g., financial aid).

• Communicate medication deductible as applicable.

• Maintain continuous communication with the medical office and/or infusion center.

• Identify and follow up on refill dates to ensure patients receive medications on time in accordance with the treatment plan.

• Other duties: perform or assist with any operation as needed to maintain workflow and meet timelines and quality standards; participate in meetings and working groups prepared by management or colleagues; stay updated on new developments, requirements, and policies.

• Escalate any extraordinary situation to the supervisor or manager; availability to attend weekly meetings.

• Other duties as assigned by the supervisor.

Minimum Requirements:

• Experience in Case Management.

• Ability to communicate in English, including reading comprehension, verbal communication, and written communication.

• Exemplary communication, customer service, and relationship-building skills with clients; including listening, speaking, and writing in both Spanish and English.

• Associate Degree as Pharmacy Technician is required.

• Valid Pharmacy Technician license is required.

• Specialized training in benefits access and pharmacy/medical requirements is preferred.

EEOC F/M/D/V

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