Case Manager – Reimbursement

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

📋 Description

• Oversee and coordinate the daily operations of an assigned caseload.

• Ensure all case components and tasks are completed promptly, facilitating the progression of cases through the required processes.

• Serve as the main point of contact for communications regarding prior authorization and appeal processing.

• Accurately and promptly communicate patient benefits and responsibilities.

• Evaluate and refer patients for specialized programs and services.

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

• Comply with quality, production, safety, and environmental standards.

• Resolve complex cases involving various disease states.

• Collaborate with both internal and external stakeholders to ensure optimal therapy initiation.

• Report patient Adverse Drug Events in accordance with pharmaceutical regulations.

• Identify product quality complaints and relay pertinent information to the manufacturer.

• Execute additional duties as assigned.

⛳️ Requirements

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

• Preferably, 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.

• 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.

• Availability from Monday to Friday, 11 AM to 8 PM EST.

🏝️ Benefits

• Opportunities for remote work.

• Competitive salary packages.

• Opportunities for career advancement.

• 401K plan with company matching.

• Tuition reimbursement programs.

• A flexible working environment.

• Paid Time Off (PTO).

• Paid holidays.

• Employee assistance programs.

• Comprehensive medical, dental, and vision coverage.

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

• Access to telemedicine services (virtual doctor appointments).

• Wellness programs.

• Adoption assistance programs.

• Short-term disability coverage.

• Long-term disability coverage.

• Life insurance options.

• Discount programs for employees.