Job Description
What we are looking for
Optime Care is seeking a Patient Navigator for our Earth City, MO location. We are looking for someone passionate about helping people get the specialized therapies they need. The Patient Navigator is a critical role that collaborates with the patient and/or caregiver, the provider, the payer, the client, and Optime Care team members throughout the entire care continuum. The Patient Navigator’s primary function is to support patients and caregivers with access to receiving therapy and long-term follow-up.
This position may require up to 50% travel based on patient and client needs. The position is expected to be in our Earth City office location when not traveling.
What the position will be doing
- Welcome new patients and caregivers, create patient profiles including insurance, and maintain ongoing system documentation of communications
- Interpret, assess, and conduct clinical educational support for patients, caregivers, and physicians
- Communicate with prescribers and their agents and the client
- Conduct insurance verification and/or authorizations for patient coverage and explain benefits to patients
- Process wholesale distribution of specialty products to an authorized facility and follow up on invoices
- Obtain and maintain prior authorizations and appeals
- Relay financial assistance information to patients
- Obtain necessary consent forms for the pharmacy, manufacturers, and patient support organizations
- Coordinate and schedule patient and caregiver logistics including, but not limited to, transportation and lodging
- Ability to travel for multiple days and connect for remote work as needed
- Dually coordinate field travel to provide in-person support to patients receiving treatment
- Be the first point of contact for patients and maintain continuity of care through in-person contact, if requested, via travel to specified treatment center cities
- Seamlessly manage, secure, and utilize travel and logistics platforms, as well as monitor expense tracking
- Regularly follow up with patients to assess and gather certain information
- Assist in preparing any ad hoc report request from clients
- Perform case management services as necessary
- Monitor external websites relating to therapy areas
- Serve as a mentor for new team members
- Collect and report any adverse events reported by patients as outlined in SOPs
- Assist with monitoring program metrics
- Performs other related duties as assigned or as necessary; be flexible and adaptable in work schedules/and work assignments driven by departmental and organizational needs.
Necessary Skills, Education & Abilities
- A bachelor's degree, or 4-year equivalent, in Nursing, RN or BSN.
- Current Board of Nursing license in good standing and a willingness to obtain compact or additional state-specific licensure as needed
- Two (2) or more years of experience with medical/pharmacy insurance verification, including benefit investigation.
- Knowledge of medical terminology is required.
- Knowledge of medical/pharmacy insurance benefits language, e.g., EOBs, deductibles, out-of-pocket expenses, co-insurance, co-pays, etc.
- Ability to define CMS 1500s, provider numbers, CPT, HCPC’s, ICD9, NCPDP and NDC codes/numbers
- Knowledge of Medicare and Medicaid billing.
- Patient Assistance Program knowledge is a plus.
- Experience with prior authorization and SMN preparation.
- Knowledge of insurance claim appeals.
- Ability to motivate a team to produce quality materials within tight timeframes and simultaneously manage several projects
- Computer literate and proficient with Microsoft Office.
- Ability to participate in and facilitate group meetings.
- Ability to thrive in a fast-paced environment with constantly changing and competing priorities.
- Excellent analytical skills and the ability to provide solutions to complex problems.
- Ability to be highly transparent, ethical, and driven. Relentless attention to detail, and the ability to be a creative self-starter and team player.
- Excellent written and verbal communication skills, and interpersonal skills required.
- Willingness to work a flexible schedule.
- Professionally utilize sound judgment, technical knowledge, and quality communication skills
About us
Optime Care is a Specialty Pharmacy dedicated to providing services to smaller patient communities. We focus on securing insurance coverage, coordinating care, and complying with therapy regimens are only a few examples. Our mission is to minimize the daily impact of living with unique disorders. After just one call, our experts begin to address everything from medication delivery and insurance reimbursement to compliance and education. Every patient receives a proactive service experience tailored to their specific needs.
Optime Care provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.
Job Tags
Full time, Local area, Remote job, Flexible hours,