Case Manager, Reimbursement

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

📋 Description

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

• Ensure that case components and tasks are completed on time, allowing cases to progress through the required processes.

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

• Engage in communication with patients, healthcare providers, field reimbursement representatives, and other external parties.

• Accurately and promptly communicate patient benefits and responsibilities.

• Assess and refer patients to appropriate special programs and services.

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

• Troubleshoot intricate cases across various disease states.

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

• Report any adverse drug events experienced by patients.

• Identify product quality complaints and relay pertinent information to manufacturers.

• Perform additional duties as assigned.

⛳️ Requirements

• Bachelor’s degree or six years of relevant 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.

• Certification is preferred but not mandatory.

• Proficient in Microsoft Office applications.

• Familiarity with medical terminology and claims processing terminology.

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

• Strong critical thinking skills and the capacity to manage multiple tasks effectively.

• Must adhere to applicable company, state, and federal safety and environmental programs and procedures.

• Required to report adverse drug events in accordance with pharmaceutical regulations.

• Must recognize product quality complaints and provide relevant information to manufacturers.

🏝️ Benefits

• Opportunities for remote work.

• Competitive salary packages.

• Opportunities for career advancement and promotion.

• 401K plan with company matching contributions.

• Tuition reimbursement program.

• Flexible work environment.

• 20 days of Paid Time Off (PTO).

• Paid holidays.

• Employee assistance programs.

• Medical, dental, and vision insurance coverage.

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

• Telemedicine services (virtual doctor appointments).

• Wellness program.

• Adoption assistance.

• Short-term disability insurance.

• Long-term disability insurance.

• Life insurance coverage.

• Discount programs.