Case Manager I

Portland, OR 97232

Posted: 07/30/2019 Employment Type: Contract Industry: Clinical & Scientific Job Number: 16145

Bayside Solutions is seeking a Case Manager I to be part of our client’ s team in Portland Oregon. This is an opportunity to work with the largest privately held pharmaceutical corporation in the world and ranks among the world' s 20 leading pharmaceutical corporations.

Our Client’ s culture is highly collaborative, offers an environment that encourages employees to expand their knowledge in order to make a profound impact on patients’ lives. This could explain why their company has been recognized as one of the “ Top Twenty Employers” in biotechnology and pharmaceuticals by Science Careers.

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 at www.baysidesolutions.com.

Case Manager I

Job Benefits:
  • An opportunity to join a patient-focused organization that is driven to develop, manufacture and commercialize medicines to treat life threatening conditions.
  • 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:
  • The Case Manager acts as a liaison between patients, providers, distributors, and insurance carriers to assure services are provided in the least restrictive and least costly manner.
  • Provide reimbursement support to patients, pharmacists, physicians, and internal sales force.
  • Educate, inform, and assist patients (and their families) and providers to navigate through the reimbursement and appeal process for the assigned product.
  • Identify barriers to reimbursement and continually identify and recommend program efficiencies to the Supervisor to promote a high quality of work by Access Solutions staff.
  • 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 including internal & external partners.
  • May conduct benefits coverage and payer research/investigations to ensure appropriate resources, compliance with payer appeal policies, practices, and timelines.
  • Periodic mandatory overtime throughout the year is required in Access Solutions Operations.  This may include, but is not limited to, high referral season (Blizzard, Enrollment renewal), new product or system launches, new line extensions, or any unexpected surge in volume or backlog situations. May include weekends as needed.

Summary of Qualifications:
  • Bachelor’ s degree is preferred.
  • 3 years of reimbursement experience preferred.
  • Knowledge of the managed care industry, including government payers.
  • Proficient in all aspects of reimbursement (i.e., benefit investigations, payer reimbursement policies, regulatory and administrative rules).
  • Understands reimbursement/funding resources and how to access these resources.
  • Demonstrates effective problem-solving skills and provides 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.
  • Able to work effectively under pressure and prioritize tasks.
  • Able to follow written Standard Operating Procedure.
  • Competencies: Communication, Inspiring & Influencing, Teamwork & Collaboration, and Achieving Results.

Allison Glogovac

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