Patient Services, Case Manager / Field/Remote Role

Glaukos #DareToDoMore – PATIENT SERVICES CASE MANAGER

Founded in 1998, Glaukos is publicly traded ophthalmic medical technology and pharmaceutical company focused on developing and commercializing novel therapies for the treatment of glaucoma, corneal disorders and retinal diseases. Our global headquarters is in Aliso Viejo, California, and we have additional locations in the United States, Canada, United Kingdom, Germany, Japan, Australia and Brazil.

How will you make an impact?

The Case Manager (CM) is an important part of the Glaukos Patient Services (GPS) team and facilitates the Patient Journey by working directly with managed care organizations to facilitate appropriate services to ensure patients have access to Glaukos’ 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.

What will you do?

• Will interpret benefit verifications including PA requirements and drug acquisition options for specific patients enrolled in GPS.
• Demonstrates effective management of CRM system while documenting pertinent information as required by standard operating procedures.
• Monitors reimbursement trends and policy changes, claim denials, underpayments, etc. and engages Reimbursement Liaisons appropriately when patient access may be jeopardized.
• Act as a single point of contact responsible for performing preliminary benefits investigations, prior authorization and appeal support as required by each case.
• Maintain and manage a caseload of enrolled patients according to GPS guidelines and deadlines; ability to prioritize tasks when complex issues arise.
• Collaborates with Reimbursement Liaisons and Patient Support Specialists to identify and eliminate barriers to access for patients enrolled in GPS.
• Provides coverage and benefits on specialty pharmacy and buy & bill acquisition options.
• Assess benefit plans for coverage and limitations and documents necessary information for provider education.
• Ability to travel, as well as overnight travel (~20%) and attendance at scheduled training and meetings.

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.

This posting is for pipelining efforts due to the growth of our Patient Services Roles.

How will you get here?

• 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 & bill acquisition, and benefit verifications, prior authorizations, claims assistance, and appeals.
• High comprehension of scientific knowledge and the ability to communicate with patients in a compliant and compassionate manner.
• Bachelor’s Degree OR 8-10 years patient services/case management experience.
• Successful navigation of complex authorization processes for specialty medications, Orphan, or Rare disease.
• 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.

Preferred:

• Medical Billing & Coding Certification a plus.
• 2 + years Eyecare, Rare Disease, Buy and Bill, or Specialty Pharmacy experience.

Generous. Innovative. Leadership-driven. Family-oriented. Socially responsible.

These are just a few of the terms our employees use to describe their experiences as a part of the Glaukos family.

Those may seem like big aspirations, but 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 eyesight of people worldwide. And because we’re a rapidly growing company with a dynamic, fast-paced culture, individual employees are empowered with more diverse and enriching challenges that might not be possible at a larger company, and more fulfillment in knowing every person and every task is directly tied to making a difference in the life of others.

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 & 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, Glaukos Corporation has been Certified as a Great Place to Work the last two years!

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.