Case Manager

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

📋 Description

• Provide both inbound and outbound telephone support to payers, patients, caregivers, specialty pharmacies, site-of-care centers, specialty distributors, pharmacy compounders, and healthcare providers.

• Facilitate the patient journey by coordinating patient benefits, product orders, and appointment scheduling.

• Deliver services on behalf of a manufacturer client through the Patient Support Program.

• Act as a dedicated contact to coordinate resources, exchange information, and ensure appropriate support.

• Manage interactions with healthcare providers and patients as an expert in benefit coordination and available support.

• Advocate for patients concerning eligibility, program enrollment, affordability support, and access to prescribed therapies.

• Build and maintain relationships with healthcare providers and patients.

• Provide ongoing program and patient information to healthcare providers.

• Navigate payer challenges while supporting prior authorization and appeals processes.

• Serve as a liaison between client contacts, Program Management, internal stakeholders, and healthcare providers.

• Maintain records in accordance with applicable standards, regulations, SOPs, Call Guides, and program materials.

• Escalate complex cases and assess situations to achieve timely outcomes.

• Deliver customer service as a brand advocate and program representative.

• Communicate patient status, prescriber feedback, coordination challenges, and program effectiveness to Program Management.

• Uphold confidentiality, privacy, ethical conduct, and professional standards.

• Complete training and adhere to corporate policies, procedures, and SOPs.

• Undertake additional tasks or projects as assigned.

⛳️ Requirements

• An Associate or Bachelor’s degree with 2 years of experience in reimbursement/insurance, healthcare billing, physician office, or health insurance processing preferred; alternatively, a High School diploma or equivalent along with 5 years of relevant experience.

• Required experience in Call Center/HUB or customer service with increasing levels of responsibility in a service-oriented environment.

• Exceptional oral and written communication skills.

• Strong working knowledge of prior authorization and appeals processes is required.

• In-depth understanding of medical and pharmacy insurance terminology and experience in reimbursement/insurance, healthcare billing, physician office, or related benefit coordination.

• Proven problem-solving and decision-making abilities are essential.

• Strong attention to detail and commitment to follow-through in communication with patients, providers, and internal/external stakeholders.

• Excellent organizational skills suited for a fast-paced environment.

• Adaptability to change while upholding Program standards.

• Strong customer service experience and skills.

• Proficient in Microsoft Excel, Word, PowerPoint, and Outlook.

• Preference for candidates who can type at least 35 words per minute with 97% accuracy.

• Flexibility to travel as necessary is preferred.

• Punctuality and reliability with a strong attendance history.

• Successful completion of a background check and, depending on the position, a drug screen.

🏝️ Benefits

• 401(k) Retirement Savings Plan with a 100% match on the first 5% contributed, with immediate vesting.

• Opportunities for advancement within a company that fosters personal and professional growth.

• A challenging and stimulating work environment that welcomes new ideas.

• An inclusive workplace that values diversity.

• A mission-driven, inclusive culture where work has a meaningful impact.