Dedicated Care Coordinator Ohio Valley

Why Patients Need You

The Inflammation and Immunology Dedicated Care Coordinator (DCC) is a non-promotional, field-based role that supports patients’ access to PDPA and VFM products when prescribed by a licensed healthcare provider. The DCC owns the continual management and progression of the patient journey — from HUB enrollment through post-fill follow-up — working directly with patients, providers, payers, HUB partners, and third-party vendors. It is a dual patient- and HCP-facing role spanning a patient journey, and the colleague in this role carries 100% ownership of every case in their assigned geography.

What You Will Achieve

The DCC is a subject-matter expert on reimbursement, access, and coverage issues that can educate patients/caregivers and healthcare providers on matters relating to reimbursement, access, and coverage. The DCC will serve as the primary point of contact for patients/caregivers and healthcare providers regarding the status of their request for reimbursement support and access assistance and will also provide updates to patients/caregivers and healthcare providers on their status as appropriate. The DCC holds end-to-end case ownership: benefits investigation and verification, prior authorization and appeals support, appointment and baseline assessment coordination, Interim Care and voucher administration, copay support, prescription triage, and scheduled post-fill follow-up.

How You Will Achieve It

Case Ownership and the Patient Journey

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Own 100% of assigned cases and drive the continual management and progression of the patient journey, from HUB enrollment through post-fill follow-up

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Be the central point-of-contact for patients/caregivers and HCP providers regarding the status of their request for reimbursement and access support related to a patient case.

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Answer questions from patients/caregivers relating to access and coverage

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Maintain a clear understanding of the patient access journey and requirements at each stage of the process, as well as the role played by patients/caregivers and HCP providers in the process

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Support access with HCPs and opted-in patients/caregivers who have been prescribed a PDPA OR VFM product

Benefits Investigation and Financial Navigation

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Conduct the Summary of Benefits (SOB) discussion required for every HUB-enrolled patient, reviewing both the product benefit structure, any associated cost and the baseline appointments for VFM

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Obtain all missing information on the Patient Enrollment Form (PEF) and verify the testing, voucher, and Interim Care options selected by the HCP office

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Walk the patient through out-of-pocket cost, deductibles, copay options, and the reimbursement program, including the impact of maximizers and accumulators

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Verify coverage for the product and for required baseline tests across both PBM and major medical insurance for VFM

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Oversee the entire prior authorization process, including submission and verification with both the patient and the provider

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Conduct benefit investigation and verification (BI/BV) calls directly with payers and patients for patients with 3rd party restrictions

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Confirm and communicate product coverage, cost, prior authorization and appeal requirements, Interim Care program PA and Appeal deadlines, and baseline assessment tests to HCP and patient

Appointment and Assessment Coordination

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Schedule, reschedule and confirm patient appointments in coordination with the patient, the provider, and the vendor

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Secure the appropriate confirmation communication back from the provider (CFT)

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Coordinate compliantly with IQVIA/MDX on patient assessment tests — confirm tests are completed and reschedule where needed

Program and Copay Administration

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Once IC is approved, manage all Interim Care (IC) program administrative requirements and deadlines with the provider and the patient, including Extended Interim Care programs

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Confirm voucher need and eligibility with the pro