Job description

From Intake to Outcomes, CareMetx is dedicated to supporting the patient journey by providing hub services, innovative technology, and decision-making data to pharmaceutical, biotechnology, and medical device innovators.

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Experience in Optometry or Ophthalmology is highly preferred for this position*

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Job Title: *Adherence Navigator (RN)

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POSITION SUMMARY: *
Adherence Navigator (RN) use effective listening and communication skills to support patients via phone and other support channels (email, SMS, etc.) following approved talking points. Adherence Navigators will speak to patients enrolled in our support programs to proactively educate them on their condition, prescribed medication, psychosocial, motivational and caregiver concerns, as well as how to best to communicate with their healthcare providers. The RN will also be responsible for speaking with providers and patients about Benefits Verifications, PAP, and copay support. Our RNs help activate patients and empower them to work on their personal treatment and health goals. This rewarding position allows nurses to support patients to help them overcome challenges, become successful in their treatment, and improve their health and quality of life. This is a remote position.

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PRIMARY DUTIES AND RESPONSIBILITIES: *

• Represent CareMetx and our clients by delivering excellent patient support that follows the CareMetx protocols and program materials.
• Provide patient and/or caregiver support, via telephone and other support channels, to address patient questions and concerns utilizing program specific approved talking points.
• Serves as a patient advocate and enhances the collaborative relationship between the payer, HCP and patient.
• Acts as a single point of contact and voice for all providers and patients.
• Document and maintain records of telephone interactions via a CRM platform.
• Utilize motivational interviewing and cognitive behavioral therapy techniques to promote positive patient outcomes.
• Participate in quality monitoring process where calls and electronic records are reviewed to ensure patient received the highest quality support possible.
• Recognize financial, medical, and legal risks based on data collected during patient interactions and follow appropriate procedures & protocols.
• Protect confidential patient health information (PHI) in accordance with HIPAA Standards and other associated regulatory bodies.
• Responsible for payer research and territory assignment management.
• Manages a regional case load.
• Review and understand all patient insurance benefit information, to the degree authorized by the SOP of the program.
• Provide all necessary documentation required to expedite prior authorization requests including demographic, authorization/referrals, National Provider Identification (NPI) number and referring physicians.
• Provide assistance to physician office staff and patients to complete and submit all necessary insurance forms and program applications in a timely manner.
• Complies with all appropriate program policies and procedures.

EXPERIENCE AND EDUCATIONAL REQUIREMENTS:

• Licensed Registered Nurse
• 3-5 years of experience in supporting patients and caregivers in a clinical setting
• Previous Nurse Telehealth and Video Support desirable

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MINIUMUM SKILLS, KNOWLEDGE AND ABILITY REQUIREMENTS: *
1. Ability to communication effectively both orally and in writing.
2. Strong computer application skills.
3. Strong interpersonal skills, team player.
4. Strong organizational and time management skills.
5. Strong attention to detail.
6. Adaptable and flexible to new situations.
7. Work from home position, requires a dedicated office space that is quiet and free from distractions

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Physical Demands*
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• While performing the duties of this job, the employee is regularly required to sit.
• The employee must occasionally lift and/or move up to 10 pounds.

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Work Environment*
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate.

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Schedule*

• Must be flexible on schedule and hours
• Some travel may be required

CareMetx considers equivalent combinations of experience and education for most jobs. All candidates who believe they possess equivalent experience and education are encouraged to apply.

At CareMetx we work hard, we believe in what we do, and we want to be a company that does right by our employees. Our niche industry is an integral player in getting specialty products and devices to the patients who need them by managing reimbursements for those products, identifying alternative funding when insurers do not pay, and providing clinical services.

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CareMetx* is an equal employment opportunity employer. All qualified applicants will receive consideration for employment and will not be discriminated against based on race, color, sex, sexual orientation, gender identity, religion, disability, age, genetic information, veteran status, ancestry, or national or ethnic origin.

Job Type: Full-time

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