Case Manager I

South San Francisco, CA | Contract

Post Date: 07/05/2017 Job ID: 11533 Industry: Clinical & Scientific

Bayside Solutions is seeking a Case Manager I  to be part of our Client’ s team in South San Francisco. This is an opportunity to work with a local Biotechnical company focusing on the discovery, development, manufacturing and commercialization of medicines to treat patients with serious or life-threatening medical conditions.

Our Company Bio:  Bayside Solutions was founded in 2001, Bayside was recognized as one of the fastest growing professional staffing companies in Northern California. The numbers tell the story: We have close to a 100% client retention rate, 700% growth in four plus years and over 95% repeat business. Our dedication to building partnership relationships with both our clients and our recruits is the key to our phenomenal success.

You can find additional information on our company website atwww.baysidesolutions.com.

Case Manager I

Job Benefits:
  • An opportunity to join a patient-focused organization that is driven to develop and commercialize novel drugs for treating rare diseases.
  • Work for a company that is local to the bay area and recognized as a leader of innovation.  
  • Competitive compensation commensurate with experience.
  • This position is eligible for medical, vision, dental benefits, paid sick time, and 401K.

Summary of Responsibilities:
  • Provide customer focused reimbursement support to patients, pharmacists, physicians and internal sales force in a high volume contact center environment (both inbound and outbound phone calls).
  • Educate, inform, and assist patients and providers to navigate through the reimbursement process for the assigned product.
  • Identify barriers to reimbursement and continually identify and recommend program efficiencies.
  • Identify and facilitate referrals to alternative coverage options and financial assistance programs for patients who are under insured or require copy assistance.
  • Establish relationships with appropriate stakeholders.
  • May conduct necessary benefits, coverage and payer research/investigations to ensure appropriate resources, compliance with payer  appeal policies, practices, timelines.
  • Educate, inform and assist patients and their families, as well as other related external or internal parties on how to navigate the appeals process.
  • Manage all steps, timing and outcomes during appeal process. Including completing written communications to patients and other external parties on appeal progress.
  • Follow-up on all appeals to obtain, where possible, authorizations and ensure appropriate status.

Required Qualifications:
  • Bachelor’ s degree preferred.
  • Understand reimbursement/funding resources and how to access these resources.
  • Knowledge of the managed care industry preferred, including government payers.
  • Demonstrate effective problem solving and excellent customer service. 
  • Excellent investigational and analytical skills with a proven ability to communicate effectively in both written and verbal format.
  • Ability to work collaboratively in a team structure and responsibly delegate next steps to appropriate team members.
  • Must be able to work effectively under pressure and prioritize tasks.

Cori Cook

I have always been a people person. As a clinical recruiter at Bayside Solutions, I get to build lasting relationships with candidates and assist them in finding job opportunities that they are as passionate about as I am about recruiting. At Bayside we believe in providing our candidates with the best possible experience, by listening to what they want in their careers and pairing them with great companies. If you’re interested in new opportunities now or would like to connect for the future, I’d love to hear from you!

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