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 an assigned caseload.

• Ensure that responsible parties complete tasks promptly and that cases progress through the required processes.

• Serve as the primary 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 observed trends to leadership.

• Follow quality, production, safety, and environmental standards and procedures.

• Address complex cases across various disease states while collaborating with both internal and external stakeholders.

• Report Adverse Drug Events in accordance with pharmaceutical regulations.

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

• Perform additional duties as assigned.

⛳️ Requirements

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

• At least two (2) 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.

• Proficient in Microsoft Office applications.

• Familiarity with medical and claims processing terminology.

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

• Strong critical thinking abilities with the capacity to manage multiple tasks simultaneously.

• Availability to work an 8-hour shift between the hours of 8 AM and 8 PM EST.

🏝️ Benefits

• Remote work opportunities.

• Competitive salary packages.

• Opportunities for career advancement and promotion.

• 401K plan with company matching contributions.

• Tuition reimbursement programs.

• Flexible working environment.

• 20 days of Paid Time Off (PTO).

• Paid holidays.

• Employee assistance programs.

• Comprehensive medical, dental, and vision coverage.

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

• Access to telemedicine services (virtual doctor appointments).

• Wellness programs.

• Adoption assistance.

• Short-term disability coverage.

• Long-term disability coverage.

• Life insurance benefits.

• Discount programs.