Case Manager – Reimbursement

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

📋 Description

• Oversee and coordinate daily operations for assigned caseload.

• Ensure timely completion of case elements and tasks, facilitating necessary progress through the process.

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

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

• Accurately and promptly communicate patient benefits and responsibilities.

• Evaluate and refer patients to special programs/services when appropriate.

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

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

• Address complex cases across various disease states.

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

• Report Adverse Drug Events in accordance with pharmaceutical regulations.

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

• Perform additional duties as assigned.

⛳️ Requirements

• Bachelor’s degree or six years of pertinent 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 and claims processing terminology.

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

• Strong critical thinking abilities.

• Capability to manage multiple tasks simultaneously.

• Availability for a shift pattern of either 11:00 AM to 08:00 PM EST.

🏝️ Benefits

• Remote work opportunities.

• Competitive salary packages.

• Opportunities for career advancement.

• 401K plan with company matching.

• Tuition reimbursement program.

• Flexible working environment.

• Discretionary Paid Time Off (PTO).

• Paid holidays.

• Employee assistance programs.

• Medical, dental, and vision insurance coverage.

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

• Telemedicine services (virtual doctor appointments).

• Wellness program initiatives.

• Adoption assistance services.

• Short-term disability coverage.

• Long-term disability coverage.

• Life insurance options.

• Discount programs available.