Case Manager

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

📋 Description

• Oversee and coordinate case management on a daily basis for the assigned caseload.

• Ensure timely completion of case elements and tasks, facilitating the necessary progression of cases.

• Serve as the primary contact for communications regarding prior authorization and appeal processing.

• Accurately and promptly communicate patient benefits and responsibilities.

• Evaluate and refer patients to special programs or services when applicable.

• Conduct quality checks on cases and report any trends to management.

• Comply with quality, production, safety, environmental, and company protocols.

• Address complex cases involving multiple disease states in collaboration with internal and external stakeholders.

• Report Adverse Drug Events in accordance with pharmaceutical regulations.

• Identify product quality complaints and relay information to the manufacturer.

• Carry out additional tasks as assigned.

⛳️ Requirements

• A Bachelor’s degree or six years of pertinent work experience.

• Preferred: Two (2) or more years of relevant experience in pharmacy benefit management.

• Experience as a Medical Assistant, Social Worker, or Senior Reimbursement Specialist is preferred.

• Certification is desirable but not mandatory.

• Proficiency in Microsoft Office applications.

• Familiarity with medical and claims processing terminology.

• Exceptional written and verbal communication skills, including the ability to provide clear instructions.

• Strong critical thinking abilities.

• Capacity to handle multiple tasks simultaneously.

• Availability for an 8-hour workday between 8 am and 8 pm EST.

🏝️ Benefits

• Opportunities for remote work.

• Competitive salary packages.

• Opportunities for career advancement.

• 401K plan with company matching.

• Tuition reimbursement programs.

• Flexible work environment.

• 20 days of Paid Time Off (PTO).

• Paid holidays.

• Employee assistance programs.

• Comprehensive medical, dental, and vision coverage.

• Health Savings Account (HSA) and Flexible Spending Account (FSA).

• Access to telemedicine services (virtual doctor appointments).

• Wellness programs.

• Adoption assistance.

• Short-term disability coverage.

• Long-term disability coverage.

• Life insurance options.

• Various discount programs.