Pharmacy Benefits Case Manager, Frx

Fresenius Medical Care Franklin , TN 37064

Posted 3 weeks ago

PURPOSE AND SCOPE:

The FreseniusRx Case Management team demonstrates a high level of case management expertise to address patient concerns and proactively plan for the maintenance of coverage. The case manager is expected to facilitate the case management process along the healthcare continuum.

PRINCIPAL DUTIES AND RESPONSIBILITIES:

  • Develops professional expertise; applies company policies and procedures to resolve a variety of issues.

  • Assesses patient prescription benefits and needs and develops action plans that provides for the introduction and continuation of therapy.

  • Maintains comprehensive understanding of the pharmacy benefit process including but not limited to financial assistance programs, insurance plans, and payer trends at a national, state, regional, and local level.

  • Assists in obtaining insurance approval and proactively plans for maintenance of coverage.

  • Works with patients, healthcare providers, insurance companies, and internal operations staff to drive outcomes.

  • Works on problems of moderate scope where analysis of situation or data requires a review of a variety of factors. Can identify complex issues and develop a plan accordingly related to benefit coverage.

  • Builds and maintains productive working relationships with internal and external customers

  • May provide assistance to junior level staff with general tasks that require a better understanding of functions, as directed by immediate supervisor.

  • May refer to senior level staff for assistance with higher level problems that may arise.

  • Escalates issues to supervisor/manager for resolution, as deemed necessary.

  • Reviews and complies with the Code of Business Conduct and all applicable company policies and procedures, local, state and federal laws and regulations.

  • Assists with various projects as assigned by direct supervisor.

  • Other duties as assigned.

Additional responsibilities may include focus on one or more departments or locations. See applicable addendum for department or location specific functions.

PHYSICAL DEMANDS AND WORKING CONDITIONS:

  • The physical demands and work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

  • This position requires up to 25% travel

SUPERVISION:

  • None

EDUCATION:

  • Bachelor's Degree required

EXPERIENCE AND REQUIRED SKILLS:

  • 5 years' related experience; or an advanced degree without experience; or equivalent directly related work experience.

  • Healthcare, Social Work, or Nursing or a related field is a plus

  • Experience in patient assistance programs, social service support, case management review preferred

  • Knowledge of benefit verification and prior authorization processes

  • Knowledge of private payer, Medicare and Medicaid structure and systems require

  • Proficiency in CRM system

  • Strong verbal and written communication skills

  • Critical thinking and problem solving

EO/AA Employer: Minorities/Females/Veterans/Disability/Sexual Orientation/Gender Identity

Fresenius Medical Care North America maintains a drug-free workplace in accordance with applicable federal and state laws.

icon no score

See how you match
to the job

Find your dream job anywhere
with the LiveCareer app.
Mobile App Icon
Download the
LiveCareer app and find
your dream job anywhere
App Store Icon Google Play Icon
lc_ad

Boost your job search productivity with our
free Chrome Extension!

lc_apply_tool GET EXTENSION

Similar Jobs

Want to see jobs matched to your resume? Upload One Now! Remove
Prescription Specialist Frx

Fresenius Medical Care

Posted 2 weeks ago

VIEW JOBS 9/30/2021 12:00:00 AM 2021-12-29T00:00 PURPOSE AND SCOPE: Assists pharmacists by working directly with physicians, physician offices, dialysis facilities, and other pharmacies to ensure that patients' medication profiles are accurately completed and that patients receive the necessary medication refills in a timely manner. PRINCIPAL DUTIES AND RESPONSIBILITIES: * Under the guidance of Registered Pharmacist, takes the appropriate actions to ensure the accuracy of patient medication files for enrolled or prospective patients and the accurate fulfillment of prescriptions for enrolled patients. Works primarily with patient medication prescriptions and with medication prescribers. * After receipt of patient authorization, contacts physicians, physician offices, dialysis facilities, and other pharmacies regarding the accuracy and fulfillment of prescriptions for enrolled or prospective patients. * Ensures that patient medication profiles are accurate with appropriate attached documents and sent in a timely manner. * Ensures that patient prescription needs are met in a timely manner. * Speaks with physicians or nurses to verify correct information about a specific prescription. * Regularly requests prescriptions and refills from physicians by telephone and/or facsimile. Follows up as necessary to ensure the timely receipt of new prescriptions. * Contacts pharmacies to execute patient medication transfers to FreseniusRx. * Collaborates with related parties for all communication with patients regarding prescription issues or other identified anomalies pertaining to prescriptions. Ensures issues are resolved according to procedures escalating the more complex issues to supervisor as necessary. * Enters, scans, and links prescription and patient data into Pharmacy Management System. Contacts appropriate parties or researches National Provider Identifier/Drug Enforcement Agency databases (NPI/DEA) when information is missing. * Works to resolve prior authorizations and if necessary, contacts the insurance company for verification when prior authorizations are required. * Ensures the required level of customer service for patients by: * Prioritizing and completing assigned tasks appropriately and in a timely manner. * Provides backup as necessary for related parties during high volume times by taking patient calls. * Assists pharmacists in dispensing as necessary. * May perform intake duties and responsibilities which include but are not limited to: * Acts as a primary liaison between clinics and provider (doctor) staff. * Works system queue Pharmacy Management System to ensure documents processed in a timely fashion. * Ensures patient Protected Health Information (PHI) is entered and updated correctly. * Transfers patient profiles between FreseniusRx pharmacy locations. * Ensures accuracy with clinic locations, addresses, and contact information. * Review and comply with the Code of Business Conduct and all applicable company policies and procedures, local, state and federal laws and regulations. * Assist with various projects as assigned by direct supervisor. * Other duties as assigned. Additional responsibilities may include focus on one or more departments or locations. See applicable addendum for department or location specific functions. PHYSICAL DEMANDS AND WORKING CONDITIONS: The physical demands and work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. EDUCATION: * High School Diploma required; Associate's Degree desirable * Pharmacy Technician Certification required * Registered or able to be registered as a pharmacy technician in the state of Tennessee EXPERIENCE AND REQUIRED SKILLS: * 1 - 2 years' related experience. * Excellent customer service, communication, organizational and interpersonal skills required. * Understands the importance of, and demonstrates a customer service philosophy. * Excellent written and verbal communication skills. * Excellent organizational and analytical skills. * Detail oriented with the ability to enter information accurately on paper and into a database system. * Proficient with PCs. * Develops a working knowledge of pharmacy dispensing regulations, data systems, and billing practices and policies. * Develops a working knowledge of standard medical abbreviations and medical terminology. EO/AA Employer: Minorities/Females/Veterans/Disability/Sexual Orientation/Gender Identity &nbsp Fresenius Medical Care North America maintains a drug-free workplace in accordance with applicable federal and state laws. Fresenius Medical Care Franklin TN

Pharmacy Benefits Case Manager, Frx

Fresenius Medical Care