Case Manager, Reimbursement

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

📋 Description

• Oversee and coordinate daily caseload management to ensure timely completion of all case elements and tasks, facilitating the progression of cases through the required processes.

• Serve as the primary contact responsible for managing prior authorization and appeal processing communications with patients, healthcare providers, field reimbursement representatives, and other external parties.

• Deliver accurate and timely communication regarding patient benefits and responsibilities.

• Appropriately assess and refer patients to special programs or services when necessary.

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

• Ensure adherence to good housekeeping practices, maintaining quality and productivity standards while complying with all relevant company, state, and federal safety and environmental regulations and procedures.

• Resolve complex cases involving multiple disease states by collaborating with key stakeholders (both internal and external) to ensure a smooth initiation of therapy.

• Report any Adverse Drug Events experienced by patients in line with pharmaceutical guidelines.

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

• Undertake additional duties as assigned.

⛳️ Requirements

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

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

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

• 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.

🏝️ Benefits

• Remote work opportunities.

• Competitive salary packages.

• Opportunities for career advancement.

• 401k plan with company matching.*

• Tuition reimbursement options.

• Flexible work environment.

• 20 days of paid time off annually (accrued).

• Paid holidays.

• Employee assistance programs available.

• Medical, dental, and vision coverage.

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

• Telemedicine services (virtual doctor appointments).

• Wellness programs.

• Adoption assistance programs.

• Short-term disability coverage.

• Long-term disability coverage.

• Life insurance options.

• Discount programs available.