McKesson Case Manager III in Louisville, Kentucky

McKesson is in the business of better health and we touch the lives of patients in virtually every aspect of healthcare. At McKesson Specialty Health, our products and services span the full continuum of specialty patient care. From the initial phases of a product life cycle and the distribution of specialty drugs, to fully integrated healthcare technology systems, practice management support, and ultimately to patient care in the communities where they live, we empower the community patient care delivery system by helping community practices advance the science, technology and quality of care.

We have a vision —that the long-term vibrancy of community care will be achieved through the leadership of physicians committed to clinical excellence and innovation, enabled by close collaboration with our organization and our deep clinical, operational and technological expertise.Every single McKesson employee contributes to our mission—by joining McKesson Specialty Health you act as a catalyst in a chain of events that helps millions of people all over the globe. You’ll collaborate on the products and solutions that help us carry out our mission to improve lives and advance healthcare. Working here is your opportunity to shape an industry that’s vital to us all.

Join our team of leaders to begin a rewarding career.

Job Summary: To drive paid therapy outcomes for patients, providers, pharmaceutical company representatives and healthcare service companies for specialty prescription drugs with reimbursement and billing challenges.

Key Responsibilities:

  • Conduct full medical and pharmacy Benefit Investigations

  • Make outbound calls to Insurance Payers, Specialty Pharmacies to obtain patient’s benefits

  • Assists offices with billing issues and claims/appeals

  • Provide consultative services where issues arise on how obstacles can be overcome in order to get patient on paid therapy.

  • Communicate with internal partners to ensure case coordination. Level of communication must be superior to service key accounts

  • Designates cases where missing information from the prescriber is an obstacle in moving the case forward to paid therapy and provides this information to the prescribers and Sales Representatives.

  • Maintains all patient confidentiality

  • When applicable, Report Adverse Events (AE) and Report on Product Quality Complaints

  • Other duties and responsibilities as assigned by supervisor based on the specific client contract.

Minimum (Required) Qualifications: (must be met in order to perform the job at the required level)

  • The Case Manger III Benefit Investigator will be in regular contact with payers, specialty pharmacies, pharmacy benefit managers, and teammates.

  • High School Diploma or Equivalent

  • Three to Five years experience in reimbursement case management, preferable in the insurance and/or pharmaceutical/biotechnology industry

  • Working knowledge of reimbursement (i.e. benefit investigation, prior authorization, pre-certification, letters of medical necessity

Preferred Qualifications: (if above and beyond the minimum required)

  • Bachelor’s Degree

  • Knowledge of Medical Terminology preferred

  • Working knowledge of drug reimbursement issues

  • Knowledge of HCPCS, CPT and ICD-9 coding

  • Ability to negotiate favorable outcomes with payor and prescribers in obtaining needed information and decisions

  • Ability to express ideas clearly in both written and oral communications

  • Strong attention to detail and ability to multi-task

  • Strong computer skills required; preferably Microsoft Word or Excel software applications

  • Data entry skills required

  • Ability to resolve problems independently

  • Ability to calculate figures and amounts such as discounts and percentages; necessary to provide correct benefit and co-pay information

  • Ability to follow instructions

  • Adaptable to changing priorities as needed

  • Have exceptional attention to detail and excellent analytical, investigation, and problem solving skills

  • Ability to manage multiple priorities concurrently

  • Responsible for case management for top key accounts

  • detailed weekly conference calls with ISS

  • detailed weekly spreadsheets on all cases (Pending and Approved) to ISS

  • detailed weekly spreadsheets to key accounts

  • verify that medication is ready to ship

  • verify that is in place for teach or injection

  • communicate with MDO and ISS on issues

  • Responsible for meeting quality and turn-around-time objectives

  • Strong customer service skills; including ability to convey compassion for patients

Physical Demands: May sit (7) to ten (10) hours per day. May be necessary to work extended hours as needed. Finger dexterity to operate office equipment required. May need to lift up to twenty-five (25) pounds on occasion. Visual acuity to see and read fine prints. Must be able to hear normal voice sounds. The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this role.

Work Environment: Work in a climate-controlled, smoke-free internal environment. These job responsibilities are executed as part of a customer service call center. The position will be located in a fast-paced organization with the potential for a variety of unplanned activities to occur simultaneously.

Benefits & Company Statement

McKesson believes superior performance – individual and team – that helps us drive innovations and solutions to promote better health should be recognized and rewarded. We provide a competitive compensation program to attract, retain and motivate a high-performance workforce, and it’s flexible enough to meet the different needs of our diverse employee population.

We are in the business of better health and we touch the lives of patients in virtually every aspect of healthcare. We partner with payers, hospitals, physician offices, pharmacies, pharmaceutical companies and others across the spectrum of care to build healthier organizations that deliver better care to patients in every setting.

But we can’t do it without you. Every single McKesson employee contributes to our mission—whatever your title, whatever your role, you act as a catalyst in a chain of events that helps millions of people all over the globe. Talented, compassionate people are the future of our company—and of healthcare. At McKesson, you’ll collaborate on the products and solutions that help us carry out our mission to improve lives and advance healthcare. Working here is your opportunity to shape an industry that’s vital to us all.

McKesson is an equal opportunity and affirmative action employer – minorities/females/veterans/persons with disabilities.

Qualified applicants will not be disqualified from consideration for employment based upon criminal history.

Agency Statement

No agencies please.

Job: Customer Care

Organization: McKesson Specialty Health

Title: Case Manager III

Location: Kentucky-Louisville

Requisition ID: 18005516