Case Manager I

South San Francisco, CA 94080

Posted: 08/20/2019 Employment Type: Contract Industry: Clinical & Scientific Job Number: 16285

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 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, MDs, distributors and insurance carrier to assure services are provided in the least restrictive and least costly manner.
  • Provides customer focused reimbursement support to patients, pharmacists, physicians and internal sales force
  • Provides Cross-Functional/Project Support/Participation; Personal Development Support.
  • Educates, informs, and assists patients and providers to navigate through the reimbursement process for the assigned product
  • Identifies barriers to reimbursement and continually identifies and recommends program efficiencies to the Supervisor to promote high quality of work by Access Solutions/GATCF staff
  • Identifies and facilitates referrals to alternative coverage options and financial assistance programs for patients who are under insured or require copy assistance
  • Establishes relationships with appropriate stakeholders including internal & external partners
  • May conduct necessary benefits, coverage and payer research/investigations to ensure appropriate resources, compliance with payer appeal policies, practices, timelines
  • Educates, informs and generally assists patients and their families, as well as other related external or internal parties on how to navigate the appeals process
  • This position may require some travel and flexibility in work shift.
  • Required to work overtime as assigned during periods of peak business needs

Summary of Qualifications:
  • Bachelors degree is preferred
  • A minimum of 3 years of reimbursement experience preferred
  • 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 delegates next steps to appropriate team members.
  • Must be able to work effectively under pressure and prioritize tasks.
  • Must be able to follow written Standard Operating Procedure
  • Candidate must have excellent knowledge of the managed care industry, including government payers.

Allison Glogovac

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