Case Manager – Reimbursement

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

📋 Description

• Oversee and coordinate the daily management of assigned caseloads.

• Ensure timely completion of case elements and tasks, facilitating the progression of cases as required.

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

• Accurately and promptly communicate patient benefits and responsibilities.

• Evaluate and direct patients to special programs and services as needed.

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

• Uphold effective housekeeping practices while adhering to company, state, and federal safety and environmental protocols.

• Resolve complex cases across various disease states.

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

• Document and report any Adverse Drug Events encountered by patients in accordance with pharmaceutical guidelines.

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

• Execute additional responsibilities as assigned.

⛳️ Requirements

• A Bachelor’s degree or six years of relevant experience in a similar field.

• Preferred two (2) or more years of experience in pharmacy benefit management.

• Experience as a Medical Assistant, Social Worker, or Senior Reimbursement Specialist is preferred.

• Certification is preferred but not mandatory.

• Proficiency in Microsoft Office applications is required.

• Familiarity with medical and claims processing terminology is essential.

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

• Strong critical thinking abilities and the capacity to manage multiple tasks simultaneously are necessary.

• Working hours consist of an 8-hour shift between 8am and 8pm EST.

• Training will occur from 9am to 6pm EST.

🏝️ Benefits

• Opportunities for remote work.

• Potential for career advancement and promotions.

• 401K plan with company matching.

• Tuition reimbursement for further education.

• Flexible working environment.

• Paid Time Off (PTO).

• Paid holidays throughout the year.

• Employee assistance programs available.

• Coverage for medical, dental, and vision needs.

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

• Telemedicine services for virtual doctor appointments.

• Wellness program to support employee health.

• Assistance for adoption processes.

• Short-term and long-term disability coverage.

• Life insurance options available.

• Discount programs for employees.