Nurse, Individualized Care

What Individualized Care contributes to Cardinal Health

Delivering an exclusive model that fully integrates direct drug distribution to the site-of-care with non-commercial pharmacy services, patient access support, and financial programs, Sonexus, a subsidiary of Cardinal Health, helps innovative specialty pharmaceutical manufacturers to establish a greater connection to their patient journey experience and access to data that drive informed decisions for tighter control and maximum product success. Personalized service and creative solutions executed through a flexible technology platform means providers are more confident in prescribing drugs, patients can more quickly obtain and complete therapy, and manufacturers can directly access more actionable insight than ever before. With all services centralized in our custom-designed facility outside of Dallas, Texas, Sonexus helps manufacturers rethink how to best serve their patients in an effective and compliant manner. 

This role encompass both clinical nursing case management and reimbursement/ patient access support responsibilities.

Clinical Nursing Case Management Services - What is expected of you and others at this level

Acts as a valuable resource, in conjunction with the patient’s health care provider, to provide individualized assistance, including education and support encompassing financial, emotional and healthcare needs. Serves as the primary point of contact for all program-related needs of the patient and the caregiver Demonstrates the highest level of commitment to serving as a patient advocate Embodies compassion, empathy and knowledge to empower the patient and caregiver Applies knowledge and expertise as an oncology nurse in the application of concepts, principles, and technical capabilities to perform varied tasks such as assisting with the appeals to claim and/or prior authorization appeals Works on projects of moderate scope and complexity Identifies possible solutions to a variety of technical problems and takes actions to resolve Applies judgment within defined parameters Work reviewed for sound reasoning and accuracy Ability to adhere to scripted or unscripted call guidelines while developing rapport and establishing a connection with the patient and caregiver

Essential Duties and Responsibilities:

Placing scheduled outbound calls to patients and care partners to support medication adherence Assessing barriers to medication adherence and developing action plans to address any barriers that are identified Providing education on medication and disease state via various forms of communication with the patient and caregiver Making referrals to advocacy and support groups for both the patient and the caregiver Placing follow up calls to assess adherence and understanding of medication regimen Receiving inbound calls from patients and caregivers Reporting adverse events and product complaints and facilitating requests for medical information Faxing communication summaries to Health Care Providers regarding barriers to adherence, reported adverse events and referrals made to third party advocacy groups

Reimbursement Access and Patient Support Case Management Responsibilities

Intake: The Nursing case manager (NCM) is responsible for handling all incoming calls (all regions) to the assigned program.  This role also includes processing enrollment applications received for any new or existing patients. The NCM must also provide accurate and timely follow-through on all call tasks and commitments and ensure that communications are clear, proper action is taken, and all internal processes are followed according to the company policies and program specific work instructions as outlined.

Benefits Coordination: The NCM will also be the dedicated subject matter expert and is responsible for relaying all benefit information, PA, Appeal, or Pre-Determination to the patient and/or health care provider.

Essential Duties and Responsibilities:

First point of contact on inbound calls, determines needs and handles accordingly Creates and completes accurate applications for enrollment Scrutinizes forms and supporting documentation for any missing information Makes all outbound calls to patient and/or provider to discuss any missing information and/or benefit related information Provides detailed activity notes as to what appropriate action is needed to initiate the reimbursement process Transfers caller to appropriate team member (when applicable) Resolves patient's questions and concerns regarding status of their request for assistance Updates internal treatment plan statuses and external pharmacy treatment statuses Notifies patients, physicians, practitioners, and or clinics of any financial responsibility of services provided as applicable Responsible for placing all outbound calls to ensure the process is complete Assesses patient’s financial ability to afford therapy and provide hand on guidance to appropriate financial assistance Must follow through on all benefit investigation rejections, including Prior Authorizations, Appeals, etc.  All avenues to obtain coverage for the product must be fully exhausted. Maintains accurate and current information for tracking and quality assurance purposes Tracks any payer/plan issues and communicate to client (Field Coordinator if applicable)

Qualifications for Dual-Role

  • Registered Nurse
  • Oncology Certification required
  • At least 5 years of hospital and/or group practice oncology experience preferred, in addition, experience with dermatology ideal
  • Current unrestricted Compact RN license in the State of Texas (Required)
  • Demonstrated high level of customer service and passion to serve patients
  • Clear knowledge of Medicare, Medicaid & Commercial payers’ policies and guidelines for coverage
  • Pharmacy and/or Medical claims billing and coding work experience preferred
  • One + years’ experience with Prior Authorization and Appeal submissions preferred
  • At least one year of telephonic nursing experience preferred
  • Excellent computer skills; ability to work in various databases, able to use Microsoft Outlook, Word, PowerPoint, and Excel, preferred

Cardinal Health is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.