Case Manager - Patient Advocate

Case Manager - Patient Advocate

Pittsburgh, PA 15275, USA Req #668

Tuesday, May 11, 2021

ConnectiveRx is a leading, technology-enabled healthcare services company. We work strategically with hundreds of biopharmaceutical manufacturers to help commercialize and maximize the benefits of specialty and branded medications. Our mission is to simplify how patients get on and stay on therapy. We fulfill our mission by providing our customers with innovative services such as patient and provider messaging, the design and operation of copay, vouchers and patient affordability programs, and hub services, all of which accelerate speed-to-therapy and help improve outcomes for manufacturers, healthcare providers and patients.

ConnectiveRx was formed in 2015 by bringing together the industry-leading business of PSKW, PDR/LDM, Careform (2017) and The Macaluso Group (2018) to advance our technology-driven expertise in providing state-of-the-art commercialization solutions. To learn more about our company, visit

Job Description

Responsible for case management of a territory for the purpose of maintaining relationships with internal and external customers. Responsible for case pull through, adherence to program service levels, and timely resolution of inquiries and escalations.

What you will do:

  • Exhibit a leadership role within the assigned territory by managing the Care Coordination process through consistently identifying complex and specific issues and developing action plans accordingly. Demonstrate accountability for action plan execution, and energetically drive for success and results. Balance the needs of individual customers (clients, clinics, field representatives, patients, etc.) with the program's contractual obligations.
  • Facilitate program services related to authorization and appeal support through tactical communication with healthcare providers, payers, and patients in order to promote product access.
  • Maximize speed to therapy by expediting product access channel fulfillment through use of technology, understanding of the payer landscape, access requirements, and customer preferences.
  • Provide claim support by answering medical billing inquires and coordinating payer review of denied or underpaid claims.
  • Deliver education and access to financial assistance offerings, including client sponsored copay programs, patient assistance programs, charitable organizations and voucher offers by assessing customer eligibility based on the program guidelines.
  • Maintains comprehensive understanding of the reimbursement process, billing/coding requirements, insurance plans, payer trends, and related resources.
  • Verify insurance coverage for new patients and re-verify insurance coverage for existing patients.
  • Strategically identify training opportunities, contribute to training activities, and create/update program SOPs and other tools as needed.
  • Participate in special projects and perform additional duties as required.

What we need from you:

  • Bachelor's Degree preferred
  • Minimum of 1 year, experience in a combination of home care management, case management review, utilization review, social service support, insurance reimbursement and patient advocacy, preferred. Related industry experience, preferred.
  • Working knowledge of healthcare, case management, and insurance reimbursement. Knowledge of call center operations with insurance verification and claims expertise. Familiarity with regulatory and organizational requirements, policies and procedures and ensure compliance.
  • Ability to become a subject matter expert within the assigned geographic territory. Provide timely and accurate responses to internal and external customers. Skillfully investigate conflicts and utilize problem solving techniques to ensure resolution of complex issues. Independently manage time and priorities. Highly proficient computer skills.

How often will we need you to travel?

There may be up to 5% travel. Don't worry, we'll give you a cool playlist to listen to.

Why work with us?

  • Excellent company culture, fun events, and volunteer opportunities
  • Competitive benefits (medical, dental, vision & more)
  • 401k package with dollar-for-dollar match-up
  • Generous PTO and paid holidays days offered
  • Opportunities to grow professionally and personally
  • Team-oriented atmosphere
  • Office snacks!!

Equal Opportunity Employer:  This employer (hereafter the Company) is an equal opportunity employer and does not discriminate in recruitment, hiring, training, promotion, or other employment policies on the basis of age, race, sex, color, religion, national origin, disability, veteran status, genetic information, or any other basis that is prohibited by federal, state, or local law. No question in this application is intended to secure information to be used for such discrimination. In addition, the Company makes reasonable accommodation to the needs of disabled applicants and employees, so long as this does not create an undue hardship on the Company or threaten the health or safety of others at work. This application will be given every consideration, but its receipt does not imply that the applicant will be employed.

Other details
  • Pay Type Salary

  • Pittsburgh, PA 15275, USA

Salary Range
$26,000.00 - 46,000.00
per Year
Salary range estimated by
Pittsburgh, PA 15201, US
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