Case Manager, Reimbursement

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

📋 Description

• Oversee and coordinate the management of assigned caseloads on a daily basis.

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

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

• Engage with patients, healthcare providers, field reimbursement representatives, and various external stakeholders.

• Accurately and promptly communicate patient benefits and responsibilities.

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

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

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

• Address complex cases that involve multiple disease states.

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

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

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

• Carry out additional duties as assigned.

⛳️ Requirements

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

• Preferred: Two (2) or more years of relevant 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 necessary.

• Familiarity with medical and claims processing terminology is required.

• Excellent 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 and promotion.

• 401K plan with company matching contributions.

• 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)/Flexible Spending Account (FSA).

• Telemedicine services (virtual doctor appointments).

• Wellness programs.

• Adoption assistance programs.

• Short-term disability coverage.

• Long-term disability coverage.

• Life insurance benefits.

• Various discount programs.