From intake to outcomes, CareMetx is dedicated to delivering industry-leading patient access solutions and support services that help patients quickly start and stay on specialty therapy treatments. We provide scalable, efficient digital hub services for pharmaceutical companies and healthcare providers, streamlining workflows with seamless integration for patient enrollment, consent, and prior authorization. Our best-in-class patient support services enhance every step of care, connecting patients, providers, and brands to drive better outcomes and accelerate time-to-therapy.

JOB TITLE: Patient Navigator Social Worker

POSITION SUMMARY: 

Under the general direction of Operations Management, the Social Worker will work closely with patients, caregivers, and providers to help patients gain access to therapy and to help ensure ongoing compliance with therapy, The contact center is a Pharmaceutical Hub Service Center assisting patients with rare diseases gain access to available medicines and medical treatments. Services provided by the Hub staff include benefit coverage investigation, prior authorization requirements analysis, product delivery and non-clinical case management. Bilingual English/Spanish is required.

PRIMARY DUTIES AND RESPONSIBILITIES: 

• Works closely with patients/caregivers and providers to help patient gain access to therapy
• Work with Specialty Pharmacy and Hub to help obtain reimbursement coverage
• Provide information to patients/caregivers on reimbursement options and financial assistance options
• Manage transition to home therapy as appropriate. Work closely with specialty infusion pharmacies and nursing agencies to help coordinate reimbursement and supplies 
• Responsible for maintaining case history for all assigned patients in the CRM system  
• Help to resolve ongoing reimbursement issues (insurance changes, PA’s, other)  
• Work with Field Sales Reps and Market Access team  
• Answer patient and medical office inquiries, as appropriate, and help resolve customer problems related to access and reimbursement 
• Provide ongoing support by making regular calls and potentially scheduling in-person meetings with the patients and caregivers  
• Provide assistance with patient access requests and the application process 
• Maintain regular and reliable attendance, including being present, on time, and prepared for work as scheduled.
• Performs other related duties as assigned.

EXPERIENCE AND EDUCATIONAL REQUIREMENTS: 

• Masters Degree in Social Worker preferred
• Minimum 3 years of Reimbursement experience (benefits investigation, prior authorization, medical benefit, Medicaid experience) preferred
• Licensed Social Worker or equivalent experience 
• Required: Bilingual with fluency in Spanish  

MINIMUM SKILLS, KNOWLEDGE AND ABILITY REQUIREMENTS: 

• Exceptional listening, written and analytical skills.  
• Proficient in Word, Excel, and PowerPoint for presentation and report development.  
• Strong knowledge of customer care processes and techniques.  
• Excellent leadership, communication, and interpersonal skills.  
• Flexible, detailed, and able to successfully adapt to change.  
• Complies with all laws, regulations, and policies that govern CareMetx activities related to the contact center.  
• Proven track record of meeting or exceeding goals and objectives.  
• Work from home position, requires a dedicated office space that is quiet and free from distractions  
• Must be able to attend in person onboarding training for 3 days (i.e. product training etc.)
• Must be able to travel extensively (overnight) 50% of the time

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.  

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.

SCHEDULE:

• Schedule flexibility including alternating coverage between 9 am -9 pm EST  
• You must live within 45 minutes of a major airport in the designated territory (east, Central, Mountain or Pacific)  
• Must be able to attend in person onboarding training for 3 days (i.e. product training etc.)  
• Must be able to travel (overnight) up to 50% of the time 
• Schedule flexibility including alternating coverage between 9am-9pm EST.

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.   

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.