Case Manager

This is a fully remote position, open to applicants in United States.

📋 Description

• Oversee designated patient cases from the point of referral to the start of therapy, ensuring case progression is timely, accurate, and compliant.

• Perform benefits investigations either electronically or via phone with insurance companies to ascertain coverage details, prior authorization needs, and patient financial obligations.

• Handle the prior authorization and appeals processes, which includes gathering plan-specific criteria and requirements, initiating and submitting requests, tracking progress, and coordinating follow-ups with plans, patients, and healthcare providers to ensure prompt resolutions.

• Recognize and facilitate patient enrollment in financial assistance initiatives, such as copay and patient assistance programs.

• Aid in communications involving patients, healthcare providers, payers, and specialty pharmacies as necessary.

• Offer educational support regarding insurance coverage, access pathways, and subsequent steps in the treatment process when required.

• Collaborate with internal teams and external partners to ensure timely initiation of therapy and adherence to service level agreements.

• Accurately document all case activities within HUB systems, adhering to standard operating procedures and regulatory mandates.

• Monitor the progress of cases and escalate complicated reimbursement issues as required.

• Respond to incoming calls from patients, caregivers, and prescribers’ offices, addressing or directing calls as necessary.

• Assist leadership in tracking and resolving escalations.

• Contribute to quality initiatives, audits, and ongoing process improvement efforts.

• Maintain compliance with HIPAA, privacy, and regulatory standards at all times.

⛳️ Requirements

• Bachelor’s Degree or equivalent experience is preferred.

• Preferred experience in patient access, HUB services, reimbursement support, specialty pharmacy, or healthcare case management.

• Familiarity with benefits investigation, prior authorization, appeals, and patient assistance programs is essential.

• Excellent communication and interpersonal skills with a focus on patient care.

• Capability to manage a high caseload in a dynamic environment while fulfilling service level expectations.

• Proficient in CRM systems and Microsoft Office applications.

• Strong organizational, analytical, and problem-solving abilities.

• Capacity to prioritize tasks and manage multiple responsibilities efficiently.

🏝️ Benefits

• Competitive compensation that acknowledges your experience, expertise, and contributions.

• Comprehensive benefits package including medical, dental, and vision insurance; accrued paid time off; 401(k) with company matching; disability and life insurance; as well as paid maternity and paternity leave.

• Company-paid holidays allowing you to relax, recharge, and focus on what is most important.

• Recognition programs, contests, and awards that honor your contributions.

• Continuous professional growth opportunities through learning, leadership development, and career advancement support.

• A collaborative culture that values your ideas and ensures your work has a meaningful impact.