Case Manager, Reimbursement

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

📋 Description

• Oversee and manage day-to-day case management for an assigned caseload.

• Ensure timely completion of tasks by responsible parties and facilitate the progression of cases as necessary.

• Serve as the primary point of contact for communications related to prior authorization and appeal processing.

• Engage with patients, healthcare providers, field reimbursement representatives, and other external stakeholders.

• Accurately and promptly communicate patient benefits and responsibilities.

• Evaluate and refer patients for specialized programs/services when suitable.

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

• Comply with quality and production standards, along with relevant company, state, and federal safety and environmental protocols.

• Address complex cases that involve multiple disease states.

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

• Report Adverse Drug Events experienced by patients, adhering to pharmaceutical regulations.

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

• Undertake additional duties as assigned.

⛳️ Requirements

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

• Preferably 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 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 possess strong critical thinking abilities along with effective multitasking skills.

• The successful candidate must be available to work a shift pattern of either 9am - 6pm EST or 10am - 7pm EST.

🏝️ Benefits

• Opportunities for remote work.

• Competitive salary packages.

• Opportunities for professional growth and promotion.

• 401K plan with company matching*

• Tuition reimbursement program.

• Flexible working environment.

• Discretionary Paid Time Off (PTO).

• Paid holidays.

• Employee assistance programs.

• Comprehensive medical, dental, and vision coverage.

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

• Access to telemedicine (virtual doctor appointments).

• Wellness program initiatives.

• Adoption assistance programs.

• Short-term disability coverage.

• Long-term disability coverage.

• Life insurance options.

• Discount programs available.