Case Manager

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

📋 Description

• Oversee assigned patient cases from the point of referral to the initiation of therapy.

• Perform benefits investigations to assess coverage, prior authorization prerequisites, and the financial obligations of patients.

• Administer the prior authorization and appeals procedures, which include initiating, submitting, tracking, and following up on requests.

• Assist in enrolling patients in copay and patient assistance programs.

• Facilitate communication between patients, healthcare providers, payers, and specialty pharmacies.

• Educate patients on insurance coverage, access pathways, and subsequent steps in their treatment journey.

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

• Accurately document case activities within HUB systems in accordance with SOPs and regulatory guidelines.

• Monitor case progression and escalate complex reimbursement challenges as needed.

• Respond to incoming inquiries from patients, caregivers, and prescriber offices.

• Track and resolve escalations with support from leadership.

• Assist in quality initiatives, audits, and ongoing process improvement efforts.

• Ensure adherence to HIPAA, privacy, and regulatory standards.

⛳️ Requirements

• Bachelor's Degree or equivalent experience is preferred.

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

• Familiarity with benefits investigations, prior authorization, appeals, and patient assistance programs.

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

• Capability to manage a high volume of cases in a dynamic environment while meeting service level expectations.

• Proficiency in CRM systems and Microsoft Office applications.

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

• Ability to prioritize tasks effectively and manage multiple responsibilities.

• Compliance with HIPAA, privacy, and regulatory standards.

🏝️ Benefits

• Competitive pay.

• Medical, dental, and vision coverage.

• Accrued paid time off.

• 401(k) with company match.

• Disability and life insurance.

• Paid maternity and paternity leave.

• Company-paid holidays.

• Recognition programs, contests, and awards.

• Opportunities for learning, leadership development, and career advancement support.