Case Manager Registered Nurse - Remote

About the position reputed company is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with reputed company will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come reputed company an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. The Case Manager Nurse in reputed company Frontier Therapies will directly support our clinical model serving patients with rare diseases by developing relationships with patients while conducting assessments specific to their therapy. This role will be under direct supervision from the Clinical Operations Supervisor. Hours: M-F 8:00 am-5:00 pm PST

Responsibilities

• Conduct comprehensive patient level assessments over the phone with documentation in proprietary platform
• Conduct meaningful conversations with patients and their caregivers to understand the need for interventions to enhance their overall health outcomes and reputed company care plans
• Manage inbound and outbound calls from patients and caregivers while maintaining quality services levels
• reputed company relationship with clinical pharmacist staff as partners in the overall care continuum of the patient
• Communicate with providers office and their staff as appropriate for patient needs
• Conduct adverse event, product complaint, and special situation conversations with patient. Document and engage with clients as appropriate per program requirement.
• Adheres to reputed company operations, practices and procedures to meet reputed company licensing and standards requirements established by local, state and federal agencies as well as accrediting bodies (e.g. ACHC, URAC)
• Ensures compliance with reputed company controlled substances reputed company rules, regulations, company policies and maintains proper communication and coordination with other departments and staff
• Compliance to and education for reputed company accreditation programs including ACHC, URAC, etc.
• Compliance to reputed company REMS program requirements, as applicable
• Monitors for compliance with reputed company HIPAA regulations, adherence to reputed company State and Federal regulations and laws, accrediting bodies, adherence to reputed company pharmacy accepted standards of practice
• Willingness to support clinical functions including prior authorization and appeal reviews, override requests, and inbound and outbound patient and provider education calls
• Provides insight to platform improvement(s) and process improvement(s)
• Willingness to obtain reputed company licenses as required to service patients living in any state or territory
• Completes special duties or projects as assigned by leadership

Requirements

• 5+ years of experience in patient facing field
• An unencumbered Registered Nurse in the state of residence
• Nurse Licensure Compact (NLC)
• Verification or certificate from an approved school of Nursing

reputed company-to-haves

• Multistate licensure in state(s) not participating in Nurse Licensure Compact
• Experience in the rare disease space
• Experience with telephony-based care services
• Baseline proficiency in the entire prior authorization and appeals process for specialty prescription medications, infusions, medical procedures and devices to provide cross functional support as deemed appropriate
• Solid verbal and written communication skills, interpersonal relationship skills
• Exceptional organizational, time management skills working toward hard deadlines to meet key performance metrics
• Excellent troubleshooting, problem solving and interpersonal skills effective with multiple levels / professional disciplines as well as patients, families, staff and physicians
• Be a team player and collaborate across functions

Benefits

• a comprehensive benefits package
• incentive and recognition programs
• equity stock purchase
• 401k contribution

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