Case Manager

This is a fully remote position, open to applicants in North Carolina.

📋 Description

• Offer specialized knowledge on insurance coverage and prevalent access and reimbursement issues impacting patients, healthcare providers, and clients.

• Inform patients, healthcare providers, and clients about Valeris access and reimbursement support tools and available programs.

• Guide HCPs, patients, and caregivers on benefits and program eligibility for individual patients.

• Educate HCP offices regarding payer processes and procedures.

• Cultivate trusted relationships with patients, prescribers, and client stakeholders concerning reimbursement questions and issues.

• Maintain relationships in accordance with applicable laws, regulations, program procedures, and industry standards.

• Assist with inbound and outbound communications to patients, caregivers, specialty pharmacies, and healthcare professionals.

• Conduct post-Benefits Investigation calls to clarify coverage options and subsequent steps.

• Handle client inquiries, including status updates specific to cases.

• Address HCP inquiries following established business rules.

• Ensure communications with client field teams adhere to agreed working protocols.

• Manage inbound calls based on program-approved FAQs.

• Direct patients to internal or external resources as needed.

• Deliver personalized case management to patients and HCPs through proactive outreach.

⛳️ Requirements

• A Bachelor's degree (or higher) is required.

• A degree in healthcare administration, social science, or similar related fields is highly preferred.

• At least two years of experience in healthcare access delivery or management is strongly preferred.

• 5-10 years of experience in insurance reimbursement, patient access, direct patient care, and/or patient education may be considered in lieu of a degree.

• Additional certifications and a minimum of five consecutive years of experience in a relevant field may also be taken into account.

• Certification examples include PACS (Prior Authorization Certified Specialist), CHES (Certified Health Education Specialist), or CCM in healthcare or social science (Certified Case Manager).

• Strong knowledge of medical terminology, coding systems (ICD-10, CPT, HCPCS), and insurance processes.

• Ability to adhere to relevant laws, regulations, program-specific operational procedures, and industry standards, including HIPAA and insurance guidelines.

• Capability to manage inbound and outbound communications to patients, caregivers, specialty pharmacies, and healthcare professionals.

🏝️ Benefits

• Medical, dental & vision coverage.

• Critical Illness, Accident, and Hospital insurance.

• 401(k) Retirement Plan with pre-tax and Roth post-tax contributions.

• Life Insurance (Voluntary Life & AD&D for the employee and dependents).

• Short and long-term disability options.

• Health Spending Account (HSA).

• Transportation benefits.

• Employee Assistance Program.

• Time Off/Leave (PTO, Vacation, or Sick Leave).