Case Manager, Reimbursement

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

📋 Description

• Oversee and coordinate day-to-day case management for the assigned caseload.

• Ensure that all case elements and tasks are completed promptly, facilitating the required progression of cases through the process.

• 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 various special programs/services, including injection services, co-pay assistance, and patient assistance programs.

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

• Comply with quality and production standards as well as relevant safety and environmental programs.

• Address complex cases across multiple disease states effectively.

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

• Report Adverse Drug Events in accordance with pharmaceutical regulations.

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

• Execute other assigned responsibilities.

⛳️ Requirements

• Bachelor’s degree or six years of equivalent professional experience.

• A minimum of two (2) years of relevant experience in pharmacy benefit management is preferred.

• 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.

• Strong critical thinking abilities.

• Capability to manage multiple tasks simultaneously.

• Willingness to work a shift pattern of either 9am - 6pm EST or 10am - 7pm EST.

🏝️ Benefits

• Remote work opportunities.

• Competitive salary packages.

• Opportunities for career advancement.

• 401K plan with company match.*

• Tuition reimbursement programs.

• 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).

• Telemedicine services (Virtual doctor appointments).

• Wellness programs.

• Adoption assistance.

• Short-term disability coverage.

• Long-term disability coverage.

• Life insurance options.

• Employee discount programs.