Case Manager, Reimbursement

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

📋 Description

• Oversee and coordinate the daily management of assigned cases.

• Ensure timely completion of case elements and tasks, facilitating progression through the necessary processes.

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

• Accurately and promptly convey patient benefits and responsibilities.

• Evaluate and refer patients for specialized programs and services.

• Conduct quality evaluations on cases and relay trends to management.

• Resolve complex cases involving various disease states.

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

• Document patient-reported Adverse Drug Events in compliance with pharmaceutical regulations.

• Identify product quality complaints and direct inquiries or written information to the manufacturer.

• Uphold good housekeeping practices while adhering to quality and production standards.

• Perform additional responsibilities as assigned.

⛳️ Requirements

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

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

• Preferred: Background as a Medical Assistant, Social Worker, or Senior Reimbursement Specialist.

• Certification is preferred but not mandatory.

• Proficient in using Microsoft Office applications.

• Familiarity with medical and claims processing terminology.

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

• Strong critical thinking abilities.

• Capability to handle multiple tasks simultaneously.

• Must be available for a full-time schedule from 11:00 AM to 8:00 PM Eastern Time, Monday through Friday.

• Candidates not located in the Eastern Time Zone must be able to work the assigned shift based on Eastern Time hours.

• Willingness and ability to travel as necessary.

• Compliance with all relevant company, state, and federal safety and environmental programs and procedures is required.

🏝️ Benefits

• Opportunities for remote work.

• Competitive salary packages.

• Opportunities for career advancement.

• 401K plan with company matching.

• Tuition assistance available after 90 days of employment.

• 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) and Flexible Spending Account (FSA) options.

• Telemedicine services for virtual doctor appointments.

• Wellness program offerings.

• Adoption assistance support.

• Short-term disability benefits available after 90 days of employment.

• Long-term disability coverage.

• Life insurance options.

• Employee discount programs.

• Occasional travel may be necessary based on client, business, or training requirements.