Senior Case Manager

Cardinal Health Sonexus™ Access and Patient Support helps specialty pharmaceutical manufacturers remove barriers to care so that patients can access, afford and remain on the therapy they need for a better quality of life. Our diverse expertise in pharma, payer and hub services allows us to deliver best-in-class solutions—driving brand and patient markers of success. We’re continuously integrating advanced and emerging technologies to streamline patient onboarding, qualification and adherence. Our non-commercial specialty pharmacy is centralized at our custom-designed facility outside of Dallas, Texas, empowering manufacturers to rethink the reach and impact of their products.

Together, we can get life-changing therapies to patients who need them—faster.

Responsibilities

The Senior Case Manager supports patient access to therapy through patient support services in accordance with the program business rules and HIPAA regulations. This role involves care coordination, insurance verification and navigation, patient advocacy, program expertise, and continuous improvement efforts.

This program will be working in the manufacturer’s CRM system, and this role will require resiliency to change as we will be working in a system that is evolving. This position is responsible for guiding the healthcare providers through the various process steps in support of their patient’s journey to therapy. These steps include patient referral intake, investigating all patient health insurance benefits, identifying & initiating prior authorization and step therapy reviews, proactively following up with various partners including the insurance payers, specialty pharmacies, support organizations, and the patient/physician to facilitate coverage and delivery of product in a timely manner.
 

• Process enrollments via inbound fax, phone, and electronically.
• Provide world-class service and receive inbound calls from patients, healthcare provider offices, SPs, and customers, striving for one-call resolution.
• Mediate effective resolution for complex payer/pharmacy issues toward a positive outcome to de-escalate
• Must meet the daily task and benefit investigation goals associated with a high enrollment volume/low patient interaction program.
• Assigned as point of contact for physician offices, patients, and FRM (Field Reimbursement Managers) for patients enrolled into the patient support program.
• Manage the entire care process with a sense of urgency from benefit investigation/verification to medication delivery, ensuring an exceptional patient experience.
• Work with specialty pharmacies, insurance providers, and healthcare provider offices to help patients gain access to therapy.
• Compliantly coordinate the exchange of patient-related information with internal and external stakeholders. 
• Conduct benefit verifications and collaborate with various healthcare providers, including physicians, pharmacies, and insurance companies, to ensure seamless coordination of patient care and timely access to necessary services.
• Help patients understand their insurance plan coverage, including out-of-pocket costs, and provide guidance on the appeals process if needed.
• Assist in obtaining insurance, prior authorization, and appeal requirements and outcomes.
• Demonstrate expertise in payer landscapes and insurance processes. Remain knowledgeable about long and short-range changes in the reimbursement environment including Medicare, Medicaid, Managed Care, and Commercial medical and pharmacy plans while planning for various scenarios that may impact prescribed products
• Actively advocate for patients' needs by navigating complex healthcare systems, addressing concerns with providers, and securing necessary approvals for treatments and medications.
• Implement strategies to promote medication adherence, including patient education, regular check-ins, and addressing potential barriers to compliance.
• Take ownership of intricate patient cases involving multiple medications, chronic conditions, or challenging adherence issues, developing personalized care plans, and monitoring progress closely
• Evaluate patient eligibility for assistance programs and assist with enrollment when applicable.
• Create and implement action plans to address patient access barriers and demonstrate accountability in execution, driving for success and results.
• Remain updated on available patient resources and diligently oversee systems and procedures to maintain accuracy and efficiency.
• Track key patient metrics, analyzing data to identify trends and areas for improvement, and generating reports for stakeholders. 
• Anticipate potential problems, refer to policies and past practices for guidance and develop and execute effective solutions.
• Provide guidance and training to junior case managers on best practices in case management, patient interaction, and navigating internal and external systems.
• Actively participate in initiatives to improve care delivery, streamline processes, and enhance patient experience within the patient support program.
• Use root-cause analysis to investigate and resolve issues affecting patient access.
• Build and maintain professional relationships with all internal and external stakeholders, including case management, patient support services, medical, sales, market access, insurance companies, specialty pharmacies, and office coordinators.   
• Proactively document and share reimbursement and other knowledge with patient support program team members through resources, consultation for complex cases, and special projects as requested.   
• Consistently maintain and document accurate data, including insurance, coverage approvals, on-going coverage requirements, and all patient and provider interactions. 
• Gain and sustain proficiency in use of the manufacturer’s CRM tool to document work and progress the patient journey.  Consistently leverage CRM reporting tools and data analytics to make strategic decisions while prioritizing patient and customer needs, while tracking and communicating areas within the CRM where refinement would be beneficial.
• Provide caseload coverage outside of assigned territory as needed.   
• Ensure compliance with company and manufacturer policies.  

What is expected of you and others at this level

• Effectively applies knowledge of job and company policies and procedures to complete a variety of assignments
• In-depth knowledge in technical or specialty area
• Applies advanced skills to resolve complex problems independently
• Works independently within established procedures; may receive general guidance on new assignments
• May provide general guidance or technical assistance to less experienced team members

Qualifications

• High school diploma or GED preferred
• Bachelor's degree in related field, or equivalent work experience in related field strongly preferred. 
• 5-8 years of industry experience with patient-facing or high touch customer interaction experience.  
• In-depth understanding of health insurance benefits, relevant state and federal laws and insurance regulations.  
• Strong understanding of pharmaceutical therapies, disease states, and medication adherence challenges.
• Ability to analyze complex situations, identify potential obstacles, and develop creative solutions to address patient needs
• Significant experience in managing complex patient cases within a healthcare setting, preferably with a focus on specialty medications.
• Excellent written and oral communication, mediation, and problem-solving skills, including the ability to connect with patients, caregivers, and providers.  
• Experience and demonstrated success working in a complex matrix to accomplish goals with a patient centric approach.  
• Strong people skills that demonstrate flexibility, persistence, creativity, empathy, and trust.    
• Robust computer literacy skills including data entry and MS Office-based software programs.  
• Ability to identify and handle sensitive issues, working independently and collaboratively within teams.   
• Consistently demonstrates effective utilization and application of resources.
• Ability to work independently, prioritize effectively, and thrive in a fast-paced, dynamic environment.
• Demonstrates a high level of adaptability and openness to new ideas, with a proven ability to embrace change and thrive in dynamic environments.
• Proficiency in managing data and analytics tools is a plus.
• Bi-lingual; Spanish language skills preferred.

TRAINING AND WORK SCHEDULES: Your new hire training will take place 8:00am-5:00pm CST, mandatory attendance is required.

This position is full-time (40 hours/week). Employees are required to have flexibility to work any of our shift schedules during our normal business hours of Monday-Friday, 7:00am- 7:00pm CST.

REMOTE DETAILS: You will work remotely, full-time. It will require a dedicated, quiet, private, distraction free environment with access to high-speed internet. We will provide you with the computer, technology and equipment needed to successfully perform your job. You will be responsible for providing high-speed internet. Internet requirements include the following:

• Maintain a secure, high-speed, broadband internet connection (DSL, Cable, or Fiber) at the remote location. Dial-up, satellite, WIFI, Cellular connections are NOT acceptable.
• Download speed of 15Mbps (megabyte per second)
• Upload speed of 5Mbps (megabyte per second)
• Ping Rate Maximum of 30ms (milliseconds)
• Hardwired to the router
• Surge protector with Network Line Protection for CAH issued equipment

Anticipated hourly range: $26.20 per hour - $33.66 per hour

Bonus eligible: No

Benefits: Cardinal Health offers a wide variety of benefits and programs to support health and well-being.

• Medical, dental and vision coverage

• Paid time off plan

• Health savings account (HSA)

• 401k savings plan

• Access to wages before pay day with myFlexPay

• Flexible spending accounts (FSAs)

• Short- and long-term disability coverage

• Work-Life resources

• Paid parental leave

• Healthy lifestyle programs

Application window anticipated to close: 06/27/2025 *if interested in opportunity, please submit application as soon as possible. The hourly range listed is an estimate. Pay at Cardinal Health is determined by multiple factors including, but not limited to, a candidate’s geographical location, relevant education, experience and skills and an evaluation of internal pay equity.

Candidates who are back-to-work, people with disabilities, without a college degree, and Veterans are encouraged to apply.

Cardinal Health supports an inclusive workplace that values diversity of thought, experience and background. We celebrate the power of our differences to create better solutions for our customers by ensuring employees can be their authentic selves each day. Cardinal Health is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, ancestry, age, physical or mental disability, sex, sexual orientation, gender identity/expression, pregnancy, veteran status, marital status, creed, status with regard to public assistance, genetic status or any other status protected by federal, state or local law.

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