Job Description

What Clinical Operations and Individualized Care contributes to Cardinal Health

Clinical Operations is responsible for providing clinical specialties support and expertise in the areas of advice and consulting, research and patient care to internal business units and external customers  

What is expected of you and others at this level

• Applies acquired job skills and company policies and procedures to complete standard tasks 

• Works on routine assignments that require basic problem resolution 

• Refers to policies and past practices for guidance 

• Receives general direction on standard work; receives detailed instruction on new assignments 

• Refers to policies and past practices for guidance 

• Receives general direction on standard work; receives detailed instruction on new assignments 

• Consults with supervisor or senior peers on complex and unusual problems 

Responsibilities

The Case Manager supports patient access to therapy through Reimbursement Support Services in accordance with the program business rules and HIPAA regulations. This position is responsible for guiding the healthcare providers through the various process steps in support of their patient’s journey to therapy. These steps include patient referral intake, investigating all patient health insurance benefits, identifying & initiating prior authorization and step therapy reviews, proactively following up with various partners including the insurance payers, specialty pharmacies, support organizations, and the patient/physician to facilitate coverage and delivery of product in a timely manner. 

• Must demonstrate efficiency and strong organizational skill 

• Mediate effective resolution for complex payer/pharmacy issues toward a positive outcome to de-escalate 

• Proactive follow-up with various contacts to ensure patient access to therapy 

• Call interactions are primarily outbound: Must demonstrate superior customer support talents that remain in compliance with standard call quality expectations. 

• Must communicate clearly and effectively in both a written and verbal format 

• Must meet the daily task and benefit investigation goals associated with a high enrollment volume/low patient interaction program. 

Qualifications

• High School Diploma or GED preferred

• 3-6 years experience in related field preferred 

• 1-2 years experience conducting and documenting patient health insurance benefit investigations, prior authorizations, and appeals, preferred  

• Knowledge of Medicare, Medicaid and Commercially insured payer common practices and policies, preferred 

• Critical and creative thinking, preferred 

• Knowledge of the Health Insurance Market Place and the Affordable Care Act preferred 

• Knowledge of Medical/Pharmacy billing and coding is preferred 

• Important to have a strong attention to detail 
  

TRAINING AND WORK SCHEDULES: Your new hire training will take place 8:00am-5:00pm CT the first week of employment.  Attendance is mandatory.

This position is full-time (40 hours/week).  Employees are required to have flexibility to work a scheduled shift of 7am-7pm CT.

REMOTE DETAILS: All U.S. residents are eligible to apply to this position.  You will work remotely, full-time. It will require a dedicated, quiet, private, distraction free environment with access to high-speed internet. We will provide you with the computer, technology and equipment needed to successfully perform your job. You will be responsible for providing high-speed internet. Internet requirements include the following:

Maintain a secure, high-speed, broadband internet connection (DSL, Cable, or Fiber) at the remote location.  Dial-up, satellite, WIFI, Cellular connections are NOT acceptable . Download speed of 15Mbps (megabyte per second)

• Upload speed of 5Mbps (megabyte per second)
• Ping Rate Maximum of 30ms (milliseconds)
• Hardwired to the router
• Surge protector with Network Line Protection for CAH issued equipment

Anticipated hourly range: $21.50 per hour - $30.65 per hour

Bonus eligible: No

Benefits: Cardinal Health offers a wide variety of benefits and programs to support health and well-being.

• Medical, dental and vision coverage

• Paid time off plan

• Health savings account (HSA)

• 401k savings plan

• Access to wages before pay day with myFlexPay

• Flexible spending accounts (FSAs)

• Short- and long-term disability coverage

• Work-Life resources

• Paid parental leave

• Healthy lifestyle programs

Application window anticipated to close: 02/14/2025 *if interested in opportunity, please submit application as soon as possible. The hourly range listed is an estimate. Pay at Cardinal Health is determined by multiple factors including, but not limited to, a candidate’s geographical location, relevant education, experience and skills and an evaluation of internal pay equity.

Candidates who are back-to-work, people with disabilities, without a college degree, and Veterans are encouraged to apply.

Cardinal Health supports an inclusive workplace that values diversity of thought, experience and background. We celebrate the power of our differences to create better solutions for our customers by ensuring employees can be their authentic selves each day.

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