Patient Services Case Manager - Field/Remote

<p class="">Here at Glaukos, we recognize the deep significance and profound meaning that comes from knowing that we can make a meaningful difference by helping improve the eyesight of people worldwide. Because we&rsquo;re a rapidly growing company with a dynamic, fast-paced culture, employees here are empowered with more diverse and enriching challenges than might not be possible at a larger company.</p> <br /><strong>Base Salary Range: $54,200 - $78,500</strong>

Aliso Viejo, CA


<h4>Founded in 1998, Glaukos Corporation is an ophthalmic medical technology and pharmaceutical company focused on novel therapies for the treatment of glaucoma, corneal disorders, and retinal diseases.</h4> <h4>Our company was the first company to bring to market Micro-Invasive Glaucoma Surgery (MIGS), the micro-invasive procedure which revolutionized the treatment and management of glaucoma. In 2012, we launched our first MIGS device&mdash;the iStent&reg;&mdash;in the United States, followed by our next-generation iStent&nbsp;inject&reg;&nbsp;device in September 2018 and iStent&nbsp;inject&reg;&nbsp;W in September 2020.</h4> <h4>In November 2019, Glaukos acquired Avedro, maker of the first and only FDA-approved cross-linking technology for progressive keratoconus. And we continue to seek to leverage our platform technologies to build a comprehensive and proprietary portfolio of micro-scale surgical and pharmaceutical therapies for glaucoma, corneal health, and retinal diseases.</h4>

keywords: position summary,compensation,collaboration,troubleshoot,duties,communication,leadership,travel,education,skills,experience,qualifications

Full time

Base Salary Range: $54,200 - $78,500

Overview: <p><strong>How will you make an impact?</strong>&nbsp;</p> <p>The&nbsp;<strong>Case Manager (CM)</strong>&nbsp;is an important part of the&nbsp;<strong>Glaukos Patient Services (GPS)</strong>&nbsp;team and facilitates the Patient Journey by working directly with managed care organizations to facilitate appropriate services to ensure patients have access to Glaukos&rsquo; sight saving technologies. The CM will provide day-to-day oversight and coordination of caseload to ensure all activities are completed timely and ensure cases move through the process as required. The CM works closely with the Reimbursement Liaison and Patient Support Specialist in providing and promoting prompt patient aid, process flow, operational integrity, accurate and high-quality outputs and process improvement to improve the overall patient experience with GPS.&nbsp;</p>
Responsibilities: <p>&nbsp;</p> <ul> <li>Assess benefit plans for coverage and limitations and documents necessary information for provider education.</li> <li>Maintain and manage a caseload of enrolled patients according to GPS guidelines and deadlines; ability to prioritize tasks when complex issues arise.</li> <li>Act as a single point of contact responsible for performing preliminary benefits investigations, prior authorization and appeal support as required by each case.</li> <li>Demonstrates effective management of CRM system while documenting pertinent information as required by standard operating procedures.&nbsp;</li> <li>Maintain case history with accurate documentation for all assigned patients.</li> <li>Troubleshoot complex cases while interfacing with key stakeholders, internal and external, to ensure optimal access to treatment for patients.</li> <li>Will interpret benefit verifications including PA requirements and drug acquisition options for specific patients enrolled in GPS.</li> <li>Collaborates with Reimbursement Liaisons and Patient Support Specialists to identify and eliminate barriers to access for patients enrolled in GPS.</li> <li>Reacts to questions related to coverage, payer policy, and approval protocols.</li> <li>Aids in navigating the appeals process as well as denied and partially paid claims.</li> <li>Provides coverage and benefits on specialty pharmacy and buy &amp; bill acquisition options.</li> <li>Monitors reimbursement trends and policy changes, claim denials, underpayments, etc. and engages Reimbursement Liaisons appropriately when patient access may be jeopardized.</li> <li>Manages all forms of communication in a timely and professional fashion to ensure patient needs are fully met and all relevant internal stakeholders are appropriately updated.</li> <li>Demonstrates positive leadership, without authority, to peers, upper management and other stakeholders by leveraging skills and expertise in patient support management.</li> <li>Successfully completes assigned training.</li> <li>Ability to travel, as well as overnight travel (~20%) and attendance at scheduled training and meetings.</li> </ul> <p>The Patient Services Case Manager consistently demonstrates uncompromised ethics and integrity while helping others understand legal and regulatory parameters related to anti-kickback statutes, fraud and abuse, off-label promotion, and OIG guidance related to patient assistance programs.&nbsp;<u>This posting is for pipelining efforts due to the growth of our Patient Services Roles.</u>&nbsp;</p>
Requirements: <ul> <li>Bachelor&rsquo;s Degree OR 8-10 years patient services/case management experience.&nbsp;</li> <li>Medical Billing &amp; Coding Certification a plus.&nbsp;</li> <li>Significant experience working with a Patient Service Center/Hub and 3+ years experience working in Patient Services and/or patient access programs, 3 + years case management, patient advocacy or patient access manager experience.&nbsp;</li> <li>2 + years Eyecare, Rare Disease, Buy and Bill, or Specialty Pharmacy experience preferred.</li> <li>3+ years case management experience with physician-administered injectables and/or medical devices, Category III CPT codes and/or miscellaneous J-codes, specialty pharmacy and buy &amp; bill acquisition, and benefit verifications, prior authorizations, claims assistance, and appeals.&nbsp;</li> <li>High comprehension of scientific knowledge and the ability to communicate with patients in a compliant and compassionate manner.</li> <li>Strong computer and technical skills and the ability to navigate software programs to process and analyze specific data with excellent verbal and communication skills.&nbsp;</li> <li>Payer/insurance coverage experience with Medicare, Medicare Advantage, VA/Tri-Care, Commercial and Medicaid plans.</li> <li>Proven record of accomplishment in achieving objectives and corporate goals with minimal direct supervision while having excellent time management and prioritization skills.&nbsp;</li> <li>Demonstrated creativity, situation analysis/problem solving skills and analytical skill ability.</li> <li>Successful navigation of complex authorization processes for specialty medications, Orphan, or Rare disease.</li> </ul> <br /> <p>We offer competitive salary (based on experience), bonus eligibility, medical/dental/vision, life insurance, stock options, 401(k) Employer Match, Employee Stock Purchase Program, generous time off &amp; paid holidays as well as time-off to volunteer in the community, plus the opportunity to work for a company that is pioneering a new glaucoma treatment class! Moreover,&nbsp;Glaukos Corporation has been Certified as a Great Place to Work the last two years!</p> <p>Glaukos Corporation is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex including sexual orientation and gender identity, national origin, disability, protected Veteran Status, or any other characteristic protected by applicable federal, state, or local law.</p>