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 all case components and tasks, facilitating the necessary progression of cases through the process.

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

• Accurately and promptly communicate patient benefits and responsibilities.

• Evaluate patients and make referrals for specialized programs or services when appropriate.

• Conduct quality checks on cases and report trends to leadership.

• Comply with quality and productivity standards as well as relevant safety and environmental protocols.

• Address complex cases that involve multiple disease states.

• Collaborate with both internal and external stakeholders to ensure a successful initiation of therapy.

• Report Adverse Drug Events in line with pharmaceutical regulations.

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

• Carry out additional duties as assigned.

⛳️ Requirements

• Bachelor’s degree or a minimum of six years of relevant work experience.

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

• Preferred: Experience as a Medical Assistant, Social Worker, or Senior Reimbursement Specialist.

• Certification is preferred but not mandatory.

• Proficient in Microsoft Office applications.

• Familiarity with medical and claims processing terminology.

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

• Must have strong critical thinking abilities and the capacity to manage multiple tasks simultaneously.

• Availability to work an 8-hour shift between the hours of 8 AM - 8 PM EST.

🏝️ Benefits

• Remote work opportunities.

• Competitive salary packages.

• Opportunities for career advancement and promotion.

• 401K plan with company matching.

• Tuition reimbursement programs.

• Flexible working environment.

• 20 days of Paid Time Off (PTO).

• Paid holidays.

• Employee assistance programs.

• Comprehensive medical, dental, and vision insurance.

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

• Telemedicine services (virtual doctor appointments).

• Wellness programs.

• Adoption assistance.

• Short-term disability coverage.

• Long-term disability coverage.

• Life insurance plans.

• Discount programs.