Case Manager

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

📋 Description

• Deliver expertise regarding insurance coverage and common access and reimbursement challenges impacting patients, healthcare providers, and clients.

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

• Guide healthcare providers, patients, and caregivers on benefits and program eligibility tailored to specific patients.

• Educate healthcare provider offices on payer processes and procedures.

• Establish trusted relationships with patients, prescribers, and client stakeholders concerning reimbursement inquiries and challenges.

• Maintain relationships in accordance with applicable laws, regulations, operating procedures, industry standards, HIPAA, and insurance guidelines.

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

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

• Handle client inquiries, including updates on case-specific statuses.

• Address healthcare provider inquiries following established business rules.

• Ensure compliant communications with client field teams under agreed-upon working protocols.

• Manage inbound calls utilizing program-approved FAQs.

• Direct patients to internal or external resources as necessary.

• Offer personalized case management and outbound communications to healthcare providers, specialty pharmacies, and patients.

⛳️ Requirements

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

• A degree in healthcare administration, social sciences, or a similar related field is highly preferred.

• A minimum of two years’ experience in healthcare access delivery or management is strongly preferred.

• Between 5-10 years of experience in insurance reimbursement, patient access, direct patient care, and/or patient education will be considered as a substitute for a degree.

• Other certifications and five or more consecutive years of experience in a relevant field may also be considered.

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

• A strong grasp of medical terminology, coding systems (ICD-10, CPT, HCPCS), and insurance processes is essential.

• Familiarity with HIPAA and insurance guidelines is required.

• Capability to support both inbound and outbound communications with patients, caregivers, specialty pharmacies, and healthcare professionals.

• Ability to adhere to program-specific operating procedures, business rules, and industry standards.

🏝️ Benefits

• Medical, dental & vision coverage.

• Critical Illness, Accident, and Hospital coverage.

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

• Life Insurance (Voluntary Life & AD&D for employees and their dependents).

• Short and long-term disability benefits.

• Health Spending Account (HSA).

• Transportation benefits.

• Employee Assistance Program.

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