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 timely completion of case elements and tasks, facilitating the necessary process flow.

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

• 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 provide trend reports to leadership.

• Maintain effective housekeeping practices while adhering to quality, production, safety, and environmental protocols.

• Resolve complex cases across various disease states.

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

• Report adverse drug events in compliance with pharmaceutical regulations.

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

• Carry out additional duties as assigned.

⛳️ Requirements

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

• Preference for 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.

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

• Strong critical thinking abilities.

• Capability to manage multiple tasks simultaneously.

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

• Candidates located outside the Eastern Time Zone must be willing to work the designated Eastern Time shift.

• Willingness and ability to travel as required.

🏝️ Benefits

• Opportunities for remote work.

• Competitive salary packages.

• Advancement opportunities for promotion.

• 401K plan with company matching.

• Tuition assistance available after 90 days of employment.

• Flexible work 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.

• Access to telemedicine services (virtual doctor appointments).

• Wellness programs.

• Adoption assistance.

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

• Long-term disability coverage.

• Life insurance options.

• Employee discount programs.