Case Manager

Description: The Hepatitis C - Case Manager is responsible for ensuring patients have timely and uninterrupted access to Hepatitis C care, treatment, and medications from initial engagement through treatment completion and SVR4/TOC.

The Case Manager serves as the primary liaison between patients, Hepatitis C Providers, Nurses, Mobile Health Testers, Medical Assistants, pharmacy partners, insurance providers, and assistance programs. The role focuses on identifying and resolving barriers related to insurance coverage, coordination of benefits, medication access, financial assistance, pharmacy processes, and patient engagement.

The Case Manager is accountable for timely follow-through, accurate documentation, proactive communication, and resolution of patient-access barriers. This position manages a high volume of active patient cases over telehealth platforms across Ohio and Pennsylvania and must be able to prioritize urgent insurance and medication-access needs.

The Case Manager provides patient-centered, nonjudgmental, culturally humble, and trauma-informed support while maintaining confidentiality and compliance with COWC policies, Hepatitis C Program SOPs, HIPAA, and applicable requirements.

Duties and Responsibilities:

Insurance & Benefits Navigation

• Verify patient insurance eligibility and coverage.
• Provide rapid insurance verification for urgent and same-day encounters.
• Assist uninsured and underinsured patients with insurance enrollment and required documentation.
• Resolve coordination of benefits and payer-related barriers.
• Maintain accurate insurance information in Epic.

Medication & Pharmacy Access

• Coordinate medication access between patients, Providers, Nurses, pharmacies, and insurance companies.
• Monitor medication approval, dispensing, shipment, and delivery.
• Identify and resolve insurance, prior authorization, formulary, copay, and pharmacy barriers.
• Monitor specialty pharmacy reports and medication tracking systems.
• Communicate medication status and unresolved barriers to the clinical team.

Patient Assistance & Financial Advocacy

• Facilitate Patient Assistance Programs, manufacturer assistance, copay assistance, and other available resources.
• Assist patients with financial assistance applications.
• Support resolution of laboratory billing and other financial barriers.
• Maintain accurate assistance tracking for Ohio and Pennsylvania.

Patient Engagement & Care Coordination

• Support patients throughout the HCV treatment continuum.
• Conduct proactive outreach to patients with outstanding barriers.
• Coordinate warm handoffs and referrals between patients and the Hepatitis C Team.
• Identify barriers related to transportation, housing, communication, technology, finances, and healthcare access.
• Support retention through treatment completion and SVR4/TOC.

Documentation & Program Support

• Maintain timely, accurate documentation in Epic.
• Maintain required COB, assistance, PAP, medication, and other program tracking systems.
• Monitor designated communication platforms and respond to patient and team needs.
• Participate in team huddles, workflow development, quality improvement, and program reporting.
• Identify recurring barriers and recommend opportunities to improve patient access and workflow.